1073509295 NPI number — CAROLINE T WILNER LCSWC

Table of content: CAROLINE T WILNER LCSWC (NPI 1073509295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073509295 NPI number — CAROLINE T WILNER LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILNER
Provider First Name:
CAROLINE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073509295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10774 HICKORY RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-992-7288
Provider Business Mailing Address Fax Number:
410-997-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10774 HICKORY RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-992-7288
Provider Business Practice Location Address Fax Number:
410-997-2880
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6199 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 6199 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120522 . This is a "JOHNS HOPKINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 159551 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160832 . This is a "VALUE OPTIONS HMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2544749 . This is a "AUSHC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 534131 04 . This is a "CAREFIRST BLUE CROSS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: *96 RULE . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 117781 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220335 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 224699 . This is a "COMPSYCHE MANAGED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292032 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292032 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1096365 . This is a "FIRST HEALTH NETWORK PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2867 007 . This is a "CAREFIRST BLUE CROSS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7822048 . This is a "AUSHC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: GRP # + 002 . This is a "TRICARE HEALTHNET" identifier . This identifiers is of the category "OTHER".




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