1205932878 NPI number — DR. SHIRLEY JEAN CAGGIANO LCSW/PHD

Table of content: DR. SHIRLEY JEAN CAGGIANO LCSW/PHD (NPI 1205932878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205932878 NPI number — DR. SHIRLEY JEAN CAGGIANO LCSW/PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAGGIANO
Provider First Name:
SHIRLEY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW/PHD
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:
1205932878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2561 WEYMOUTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH RIDGE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63049-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
656-376-8894
Provider Business Mailing Address Fax Number:
636-789-5815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10626 HIGHWAY 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63050-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-789-2747
Provider Business Practice Location Address Fax Number:
636-789-5815
Provider Enumeration Date:
09/14/2006

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:  000734 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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