1891890273 NPI number — ROSEMARIE F HALL LCSW R

Table of content: ROSEMARIE F HALL LCSW R (NPI 1891890273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891890273 NPI number — ROSEMARIE F HALL LCSW R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
ROSEMARIE
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW R
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:
1891890273
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:
8055 SAND RIDGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNEVELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-896-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8021 ROUTE 12 VILLAGE PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNEVELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13304-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-896-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

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:  R040913 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000917895001 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139015 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0252459 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426031700 . This is a "FIDELRS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10083601 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 615037 . This is a "MVP HEALTHPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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