1265536965 NPI number — TERESA MARTIN JENKINS LCSW

Table of content: (NPI 1083899199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265536965 NPI number — TERESA MARTIN JENKINS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
TERESA
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
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:
MARTIN
Provider Other First Name:
TERESA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265536965
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:
1320 CENTRAL PK BLVD STE 229
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:
22401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-548-4842
Provider Business Mailing Address Fax Number:
540-548-4824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 CENTRAL PK BLVD STE 229
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-548-4842
Provider Business Practice Location Address Fax Number:
540-548-4824
Provider Enumeration Date:
09/12/2006

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:  0094 002716 , 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: 220417 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 115680 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 227773 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 329731 . This is a "MAMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 329731 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5925667 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0814 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 329731 . This is a "OCI" identifier . This identifiers is of the category "OTHER".