1285635516 NPI number — MRS. CAROLYN SUE HEATH LSW

Table of content: MRS. CAROLYN SUE HEATH LSW (NPI 1285635516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285635516 NPI number — MRS. CAROLYN SUE HEATH LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEATH
Provider First Name:
CAROLYN
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
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:
1285635516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 W POMFRET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-258-0214
Provider Business Mailing Address Fax Number:
717-258-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 W POMFRET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-258-0214
Provider Business Practice Location Address Fax Number:
717-258-3158
Provider Enumeration Date:
08/09/2005

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:  014772 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP1600X , with the licence number: 014772 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 014772 , 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)

  • Identifier: 1012248330001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50047763 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "MAIL HANDLERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "QUEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "UNITED BEHAVIORAL HLTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "HIGHMARK FEDERAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 128194 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 195761000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2033298 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 250976 . This is a "COMPSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "ALLIANCE WORK PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "HEALTHNET TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "PRIME SOURCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "TEAM EAP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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