1548287071 NPI number — MRS. CAROL A DIETRICH MSW

Table of content: MRS. CAROL A DIETRICH MSW (NPI 1548287071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548287071 NPI number — MRS. CAROL A DIETRICH MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIETRICH
Provider First Name:
CAROL
Provider Middle Name:
A
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:
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:
1548287071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 S CHURCH STREET
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-9244
Provider Business Mailing Address Fax Number:
410-876-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 S CHURCH STREET
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-848-9244
Provider Business Practice Location Address Fax Number:
410-876-5042
Provider Enumeration Date:
07/17/2006

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:  02708 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z16901100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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