1851338180 NPI number — MS. CONCETTA CAROL CHEVALIER LMFT

Table of content: MS. CONCETTA CAROL CHEVALIER LMFT (NPI 1851338180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851338180 NPI number — MS. CONCETTA CAROL CHEVALIER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEVALIER
Provider First Name:
CONCETTA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1851338180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 JULIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02911-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-231-4220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-737-0820
Provider Business Practice Location Address Fax Number:
401-737-0830
Provider Enumeration Date:
06/02/2006

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:  00049 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023290 . This is a "BEACON HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: FM49368 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411282 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTH . This is a "6238130" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 26905-8 . This is a "R.I. BLUE CROSS BLUE SHIE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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