1609177807 NPI number — PATRICIA ANN MOOREHEAD LCSW-C

Table of content: PATRICIA ANN MOOREHEAD LCSW-C (NPI 1609177807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609177807 NPI number — PATRICIA ANN MOOREHEAD LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOOREHEAD
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COMEAU
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609177807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 EMERYVILLE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBERRY TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-5020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-609-5002
Provider Business Mailing Address Fax Number:
724-299-8964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 EMERYVILLE DR STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-609-5002
Provider Business Practice Location Address Fax Number:
724-299-8964
Provider Enumeration Date:
11/04/2010

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:  17685 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 517251 . This is a "OPTUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 259147-000 . This is a "MAGELLAN HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST GHMSI & REGIONAL PPN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "COMMERCIAL INS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7840093 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609500300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 346646 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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