1477718575 NPI number — MRS. CHARITY M. J. HUMPHREY MSW

Table of content: MRS. CHARITY M. J. HUMPHREY MSW (NPI 1477718575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477718575 NPI number — MRS. CHARITY M. J. HUMPHREY MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHREY
Provider First Name:
CHARITY
Provider Middle Name:
M. J.
Provider Name Prefix Text:
MRS.
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:
DIXON
Provider Other First Name:
CHARITY
Provider Other Middle Name:
M. J.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477718575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6940 RARITAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46221-4886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-821-0849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 DRAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46131-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-736-0014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2008

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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