1073721338 NPI number — PROF. GILBERT DARRIN CARDE LMSW

Table of content: PROF. GILBERT DARRIN CARDE LMSW (NPI 1073721338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073721338 NPI number — PROF. GILBERT DARRIN CARDE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDE
Provider First Name:
GILBERT
Provider Middle Name:
DARRIN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
M

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:
1073721338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE
Provider Second Line Business Mailing Address:
STE 1D03
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-5611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-6633
Provider Business Mailing Address Fax Number:
616-776-2934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 HARMON AVE
Provider Second Line Business Practice Location Address:
STE 1D03
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-6633
Provider Business Practice Location Address Fax Number:
616-776-2934
Provider Enumeration Date:
05/18/2007

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: 1041C0700X , with the licence number:  6801021536 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7000020881 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 352744000 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: PVM190358 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80-0-89-5748-0 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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