1225081003 NPI number — MS. MARTHA CATHERINE KOHL LCSW-R

Table of content: MS. MARTHA CATHERINE KOHL LCSW-R (NPI 1225081003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225081003 NPI number — MS. MARTHA CATHERINE KOHL LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHL
Provider First Name:
MARTHA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
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:
1225081003
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:
259 MOUNT VERNON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14620-2449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-461-3469
Provider Business Mailing Address Fax Number:
585-461-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14420-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-746-3410
Provider Business Practice Location Address Fax Number:
585-461-4904
Provider Enumeration Date:
05/19/2006

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:  R069430-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000929206002 . This is a "HEALTH NOW (BCBS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 180089FK . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000929206001 . This is a "HEALTH NOW (BCBS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7748784 . This is a "AETNA (RCIPA)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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