1205960994 NPI number — CAPITOL REGION EDUCATION COUNCIL

Table of content: MISS ALYSEN JANAE WALLACE MS, LPCA (NPI 1912244369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205960994 NPI number — CAPITOL REGION EDUCATION COUNCIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL REGION EDUCATION COUNCIL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACADEMY OF INTERNATIONAL STUDIES
Provider Other Organization Name Type Code:
3
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:
1205960994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 PROGRESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06109-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-529-4260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 BLUE HILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-242-7834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TARTAGLIA
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF STUDENT SERVICES
Authorized Official Telephone Number:
860-509-3732

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  0382 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004250601 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0382 . This is a "OUTPATIENT CLINIC LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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