1366593865 NPI number — HILLARY STERN LCSW

Table of content: HILLARY STERN LCSW (NPI 1366593865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366593865 NPI number — HILLARY STERN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
HILLARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1366593865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD CENTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06250-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-208-8519
Provider Business Mailing Address Fax Number:
860-423-3566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 A CONANTVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD CENTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-208-8519
Provider Business Practice Location Address Fax Number:
860-429-2227
Provider Enumeration Date:
01/13/2007

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: 1041C0700X , with the licence number:  006032 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7306143 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140006032CT01 . This is a "ANTHEM CENTURY - PPO PRODUCTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004267416 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140006032CT01 . This is a "ANTHEM BLUE CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 395038 . This is a "HEALTHNET MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".