1467425470 NPI number — MRS. KERRY J BOONE-SAVINSKY LCSW

Table of content: MRS. KERRY J BOONE-SAVINSKY LCSW (NPI 1467425470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467425470 NPI number — MRS. KERRY J BOONE-SAVINSKY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOONE-SAVINSKY
Provider First Name:
KERRY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
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:
1467425470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 VIRGINIA BEACH BLVD # 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-714-1838
Provider Business Mailing Address Fax Number:
757-321-6269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 N LYNNHAVEN RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-912-6214
Provider Business Practice Location Address Fax Number:
757-321-6269
Provider Enumeration Date:
02/09/2006

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:  0904005305 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 278445 . This is a "ANTHEM HEALTH KEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00129392 . This is a "MCARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 278445 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 327264 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2109308 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008952833 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081722M . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 221420 . This is a "COM PSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 560284 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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