1073645016 NPI number — LAREINE F. HUNGERFORD LCSW-R

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073645016 NPI number — LAREINE F. HUNGERFORD LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNGERFORD
Provider First Name:
LAREINE
Provider Middle Name:
F.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLOPPER
Provider Other First Name:
LAREINE
Provider Other Middle Name:
F.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073645016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 ASHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14222-1542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-881-2296
Provider Business Mailing Address Fax Number:
716-886-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14222-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-881-2296
Provider Business Practice Location Address Fax Number:
716-886-0701
Provider Enumeration Date:
03/12/2007

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: 101YM0800X , with the licence number:  R024662-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: U01301457 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6207985 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 174489 . This is a "COMPSYCH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00020249201 . This is a "UNIVERA EXELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272891 . This is a "PHCS (PIN)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000504604003 . This is a "BCBS PAYEE ID NO." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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