1619267770 NPI number — CAROL ANN TRYON MSW

Table of content: CAROL ANN TRYON MSW (NPI 1619267770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619267770 NPI number — CAROL ANN TRYON MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRYON
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
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:
1619267770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29222 RANCHO VIEJO RD
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-1041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-429-6888
Provider Business Mailing Address Fax Number:
949-429-6868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29222 RANCHO VIEJO RD
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-429-6888
Provider Business Practice Location Address Fax Number:
949-429-6868
Provider Enumeration Date:
04/11/2011

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:  LCS26250 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LCS 26250 . This is a "BOARD OF BEHAVIORAL SCIENCES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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