1558408690 NPI number — KENNY MEAGHER MFTI

Table of content: KENNY MEAGHER MFTI (NPI 1558408690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558408690 NPI number — KENNY MEAGHER MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEAGHER
Provider First Name:
KENNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFTI
Provider Gender Code:
M

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:
1558408690
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:
2476 BALMORAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94587-1864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-441-8824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39217 LIBERTY ST
Provider Second Line Business Practice Location Address:
SUITE B 10
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-791-3322
Provider Business Practice Location Address Fax Number:
510-791-3325
Provider Enumeration Date:
01/30/2007

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: 106H00000X , with the licence number:  MFTI 48558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: IMF48558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 101YM0800X . This is a "MENTAL HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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