1487756672 NPI number — MS. KATHARINE B LUSCOMB LCMHC

Table of content: MS. KATHARINE B LUSCOMB LCMHC (NPI 1487756672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487756672 NPI number — MS. KATHARINE B LUSCOMB LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUSCOMB
Provider First Name:
KATHARINE
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
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:
1487756672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 OLD GULF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORETOWN
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05660-9112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-496-7128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-5216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-863-0220
Provider Business Practice Location Address Fax Number:
802-863-0444
Provider Enumeration Date:
09/01/2006

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: 101YM0800X , with the licence number:  068-0000066 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007079 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 610245 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 102494 . This is a "MAGELLAN OF MASS." identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 18413 . This is a "BC/BS OF VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 7607450 . This is a "AETNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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