1710193552 NPI number — RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA

Table of content: (NPI 1710193552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710193552 NPI number — RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY OF VIRGINIA CENTER FOR CLINICAL PSYCHOLOGY SERVICES
Provider Other Organization Name Type Code:
3
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:
1710193552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 EMMET STREET, SOUTH
Provider Second Line Business Mailing Address:
P.O. BOX 400270
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22904-4270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-924-7034
Provider Business Mailing Address Fax Number:
434-924-4621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 EMMET STREET, SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22904-4270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-924-7034
Provider Business Practice Location Address Fax Number:
434-924-4621
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
PATTY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CENTER MANAGER
Authorized Official Telephone Number:
434-924-1406

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  103TCO700X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 230305 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 274981000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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