1053321372 NPI number — ROSEMARY QUAGAN LICSW

Table of content: ROSEMARY QUAGAN LICSW (NPI 1053321372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053321372 NPI number — ROSEMARY QUAGAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAGAN
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1053321372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON GROVE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28366-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-567-6194
Provider Business Mailing Address Fax Number:
910-567-5342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3331 EASY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28334-7988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-567-6194
Provider Business Practice Location Address Fax Number:
508-860-7990
Provider Enumeration Date:
08/09/2006

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: 104100000X , with the licence number:  11613 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C008481 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0300010 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97477301 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042485308 . This is a "NETWORK HEALTH-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1300709 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56118 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1001250 . This is a "BEACON-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com