1437206083 NPI number — LUCY S RAIZMAN MSW

Table of content: LUCY S RAIZMAN MSW (NPI 1437206083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437206083 NPI number — LUCY S RAIZMAN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAIZMAN
Provider First Name:
LUCY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1437206083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 FERNBROOK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYNCOTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19095-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-345-8454
Provider Business Mailing Address Fax Number:
215-628-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921-A NORTH BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SPRINGHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19477-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-8454
Provider Business Practice Location Address Fax Number:
215-628-4622
Provider Enumeration Date:
01/05/2007

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:  CW007735L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: MF000131 , 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)