1033279765 NPI number — MS. TERESA A. KEY-PICIUCCO PYSCH ASSISTANT

Table of content: MS. TERESA A. KEY-PICIUCCO PYSCH ASSISTANT (NPI 1033279765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033279765 NPI number — MS. TERESA A. KEY-PICIUCCO PYSCH ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEY-PICIUCCO
Provider First Name:
TERESA
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PYSCH ASSISTANT
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:
1033279765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 W CHURCH ST STE 318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43055-5050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-281-1777
Provider Business Mailing Address Fax Number:
740-281-1778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 W CHURCH ST STE 318
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-5050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-281-1777
Provider Business Practice Location Address Fax Number:
740-281-1778
Provider Enumeration Date:
12/11/2006

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: 103TC0700X , with the licence number:  821 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1291 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 588982000 . This is a "MAGELLAN MIS NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: Y01291 . This is a "HEALTH PLAN ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0005456001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001719061 . This is a "MSBCBS SERVICE ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2171255 . This is a "CIGNA ID NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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