1033454061 NPI number — MRS. SHERRI LYNN HALUCHA MFT

Table of content: MRS. SHERRI LYNN HALUCHA MFT (NPI 1033454061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033454061 NPI number — MRS. SHERRI LYNN HALUCHA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALUCHA
Provider First Name:
SHERRI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSEN
Provider Other First Name:
SHERRI
Provider Other Middle Name:
LYNN
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:
1033454061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON BAYS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11946-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-276-5271
Provider Business Mailing Address Fax Number:
631-728-5369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON BAYS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11946-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-276-5271
Provider Business Practice Location Address Fax Number:
631-728-5369
Provider Enumeration Date:
12/03/2012

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: 106H00000X , with the licence number:  MFC 37604 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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