1215014576 NPI number — MRS. DEBORAH ANN JOCKIN L.C.S.W.

Table of content: MRS. DEBORAH ANN JOCKIN L.C.S.W. (NPI 1215014576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215014576 NPI number — MRS. DEBORAH ANN JOCKIN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOCKIN
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.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:
HUDAK
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215014576
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:
8400 W HARRISON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22407-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-786-3978
Provider Business Mailing Address Fax Number:
540-310-0791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 PROGRESS ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22401-3356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-310-0797
Provider Business Practice Location Address Fax Number:
540-310-0791
Provider Enumeration Date:
11/01/2006

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: 1041C0700X , with the licence number:  0904-004481 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 130640 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 209123 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8922390 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209122 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5394030 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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