1225128606 NPI number — MRS. MAUDENE SHERMAN LCSW

Table of content: MRS. MAUDENE SHERMAN LCSW (NPI 1225128606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225128606 NPI number — MRS. MAUDENE SHERMAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERMAN
Provider First Name:
MAUDENE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1225128606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 453
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASSAWADOX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23413-0453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-665-1260
Provider Business Mailing Address Fax Number:
757-665-4184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19056 GREENBUSH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKSLEY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-665-1260
Provider Business Practice Location Address Fax Number:
757-665-4184
Provider Enumeration Date:
10/13/2006

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: 101YP2500X , with the licence number:  0904003024 , 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: 004945417 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285310 . This is a "HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C05541 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 135834 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 394183 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 251687 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 89386 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com