1720120884 NPI number — KATHLEEN G SAWLER LICSW

Table of content: KATHLEEN G SAWLER LICSW (NPI 1720120884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720120884 NPI number — KATHLEEN G SAWLER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAWLER
Provider First Name:
KATHLEEN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1720120884
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:
34 JOHNSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWMARKET
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03857-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-767-2110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GREENLEAF WOODS DRIVE, SUITE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-767-2110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007

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: 1041C0700X , with the licence number:  955 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30424069 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Y008716NH02 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".