1265693832 NPI number — LISA HEATHER TORBERT MS, CADC

Table of content: LISA HEATHER TORBERT MS, CADC (NPI 1265693832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265693832 NPI number — LISA HEATHER TORBERT MS, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORBERT
Provider First Name:
LISA
Provider Middle Name:
HEATHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CADC
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:
1265693832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1169 WALKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19904-6539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-678-3433
Provider Business Mailing Address Fax Number:
302-678-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1169 WALKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-6539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-678-3433
Provider Business Practice Location Address Fax Number:
302-678-2232
Provider Enumeration Date:
06/17/2008

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2002103334 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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