1184740185 NPI number — MRS. KELLY A PULVER LCPC

Table of content: MRS. KELLY A PULVER LCPC (NPI 1184740185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184740185 NPI number — MRS. KELLY A PULVER LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PULVER
Provider First Name:
KELLY
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIEDERER
Provider Other First Name:
KELLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184740185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 POPLAR SPRINGS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEWARTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17363-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-928-0631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 S MAIN ST BLDG A
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-5447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-914-4012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC2184 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600007820 . This is a "MAGELLAN BH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "7265936" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 88750701 . This is a "CAREFIRST RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: QC40CO . This is a "CAREFIRST BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M3280013 . This is a "BCBS NATL CAPITAL REGION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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