1245503697 NPI number — MS. JACQUELINE M. MCNAMEE LMFT

Table of content: MS. JACQUELINE M. MCNAMEE LMFT (NPI 1245503697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245503697 NPI number — MS. JACQUELINE M. MCNAMEE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNAMEE
Provider First Name:
JACQUELINE
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1245503697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 DEER RUN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-240-5514
Provider Business Mailing Address Fax Number:
203-924-2643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-6528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-240-5514
Provider Business Practice Location Address Fax Number:
203-924-2643
Provider Enumeration Date:
02/15/2012

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: 106H00000X , with the licence number:  001403 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com