1861687105 NPI number — MRS. CRYSTAL CENTENO BAJEK MSW, LCSW

Table of content: MRS. CRYSTAL CENTENO BAJEK MSW, LCSW (NPI 1861687105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861687105 NPI number — MRS. CRYSTAL CENTENO BAJEK MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAJEK
Provider First Name:
CRYSTAL
Provider Middle Name:
CENTENO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CENTENO
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861687105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 VALLEY GLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUTMAN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28166-7732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 OLD MOCKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-1930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-838-7450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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