1194969022 NPI number — MRS. CATHY DIANE BIRCKETT M.S.W.

Table of content: MRS. CATHY DIANE BIRCKETT M.S.W. (NPI 1194969022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194969022 NPI number — MRS. CATHY DIANE BIRCKETT M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRCKETT
Provider First Name:
CATHY
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREENE
Provider Other First Name:
CATHY
Provider Other Middle Name:
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:
1194969022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 W UPSAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19119-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-843-0203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 N BROAD ST
Provider Second Line Business Practice Location Address:
RM 821
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-568-0860
Provider Business Practice Location Address Fax Number:
215-568-0769
Provider Enumeration Date:
04/22/2009

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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