1104990282 NPI number — MS. ANDREA JOY SIME LCSW

Table of content: MS. STACY N HARRIS BA (NPI 1417165044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104990282 NPI number — MS. ANDREA JOY SIME LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIME
Provider First Name:
ANDREA
Provider Middle Name:
JOY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1104990282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 S 40TH ST STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-5248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-441-9280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S 40TH ST STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-5248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-9280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006

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: 101YM0800X , with the licence number:  501 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 100 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 68506A010 . This is a "TRICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 052174 . This is a "VALUE OPTIONS #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 82555 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: P00390674 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47075636926 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5161 . This is a "MIDLANDS INSURANCE #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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