1205006400 NPI number — MS. ELLIE ANITA YOVANOVICH MSW LSW PA AND NJ LS

Table of content: MS. ELLIE ANITA YOVANOVICH MSW LSW PA AND NJ LS (NPI 1205006400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205006400 NPI number — MS. ELLIE ANITA YOVANOVICH MSW LSW PA AND NJ LS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOVANOVICH
Provider First Name:
ELLIE
Provider Middle Name:
ANITA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LSW PA AND NJ LS
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:
1205006400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 BREEZY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERWINA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
610-294-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 RIVER ROAD
Provider Second Line Business Practice Location Address:
ALTERNATIVES
Provider Business Practice Location Address City Name:
UPPER BLACK EDDY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-294-5054
Provider Business Practice Location Address Fax Number:
610-294-5054
Provider Enumeration Date:
03/04/2008

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: 101Y00000X , with the licence number:  44SL04636400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: SW125457 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com