1780889451 NPI number — KENT RAPHAEL HALPERN MFT

Table of content: KENT RAPHAEL HALPERN MFT (NPI 1780889451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780889451 NPI number — KENT RAPHAEL HALPERN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALPERN
Provider First Name:
KENT
Provider Middle Name:
RAPHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
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:
1780889451
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:
1400 EMELINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-454-4170
Provider Business Mailing Address Fax Number:
831-454-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 EMELINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-1976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-454-4170
Provider Business Practice Location Address Fax Number:
831-454-4663
Provider Enumeration Date:
06/20/2007

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:  LMFT 17846 , 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: LMFT 17846 . This is a "PROFESSIONAL LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".