1245404193 NPI number — JOHN J. MUGGIVAN LCSW

Table of content: JOHN J. MUGGIVAN LCSW (NPI 1245404193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245404193 NPI number — JOHN J. MUGGIVAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUGGIVAN
Provider First Name:
JOHN
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1245404193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 VETERANS MEMORIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70005-2837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-273-5877
Provider Business Mailing Address Fax Number:
504-305-8510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 VETERANS MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70005-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-273-5877
Provider Business Practice Location Address Fax Number:
504-305-8510
Provider Enumeration Date:
04/22/2008

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: 1041C0700X , with the licence number:  1053 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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