1912213307 NPI number — CAROL DIANE MCNITT LCSW-C

Table of content: CAROL DIANE MCNITT LCSW-C (NPI 1912213307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912213307 NPI number — CAROL DIANE MCNITT LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNITT
Provider First Name:
CAROL
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
CAROL
Provider Other Middle Name:
DM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912213307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWNSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21032-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-472-0617
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2635 RIVA RD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
104-573-9000
Provider Business Practice Location Address Fax Number:
410-573-9001
Provider Enumeration Date:
08/24/2010

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:  15806 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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