1851486864 NPI number — MS. ANITA LOUISE RINGO LCSW

Table of content: MS. ANITA LOUISE RINGO LCSW (NPI 1851486864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851486864 NPI number — MS. ANITA LOUISE RINGO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RINGO
Provider First Name:
ANITA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1851486864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 WAYNE DR APT 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-937-7085
Provider Business Mailing Address Fax Number:
215-732-8240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 S 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 1405
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-6231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-732-6308
Provider Business Practice Location Address Fax Number:
215-732-8240
Provider Enumeration Date:
10/04/2006

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: 1041C0700X , with the licence number:  LC2773 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: CW016399 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 104000000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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