1194737494 NPI number — LORI GUNNER KOLLE LCSW-C

Table of content: LORI GUNNER KOLLE LCSW-C (NPI 1194737494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194737494 NPI number — LORI GUNNER KOLLE LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLLE
Provider First Name:
LORI
Provider Middle Name:
GUNNER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
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:
1194737494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 WOOD HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-8724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-838-4200
Provider Business Mailing Address Fax Number:
301-309-2596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WOOD HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-8724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-838-4200
Provider Business Practice Location Address Fax Number:
301-309-2596
Provider Enumeration Date:
08/13/2006

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:  05944 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 0904001916 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 530196598 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 235751 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 54974 . This is a "UBH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 901301600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132205 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 156610000 . This is a "MAGELLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: A2840039 . This is a "BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 5144277 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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