1073882676 NPI number — MR. PARKER G HAMPSON LPC

Table of content: MR. PARKER G HAMPSON LPC (NPI 1073882676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073882676 NPI number — MR. PARKER G HAMPSON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMPSON
Provider First Name:
PARKER
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1073882676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 FARVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06804-1831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-470-4637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-337-9943
Provider Business Practice Location Address Fax Number:
203-337-9986
Provider Enumeration Date:
12/28/2011

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:  001259 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 001259 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008038185 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008042339 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008023170 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008024427 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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