1003140740 NPI number — JULIE KRISTEN RANDALL YORK LCPC

Table of content: JULIE KRISTEN RANDALL YORK LCPC (NPI 1003140740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003140740 NPI number — JULIE KRISTEN RANDALL YORK LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YORK
Provider First Name:
JULIE
Provider Middle Name:
KRISTEN RANDALL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANDALL
Provider Other First Name:
JULIE
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003140740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04967-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-299-6052
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 COMMERCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOWHEGAN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04976-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-873-2136
Provider Business Practice Location Address Fax Number:
207-660-4529
Provider Enumeration Date:
09/29/2009

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: 101YP2500X , with the licence number:  CC5237 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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