1316289531 NPI number — JONATHAN STERN, M.S., L.P.C., L.A.D.C., COUNSELING AND PSYCHOTHERAPY S

Table of content: (NPI 1316289531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316289531 NPI number — JONATHAN STERN, M.S., L.P.C., L.A.D.C., COUNSELING AND PSYCHOTHERAPY S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN STERN, M.S., L.P.C., L.A.D.C., COUNSELING AND PSYCHOTHERAPY S
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316289531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 DIXWELL AVE
Provider Second Line Business Mailing Address:
SUITE B-5
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-916-5496
Provider Business Mailing Address Fax Number:
203-265-1216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 DIXWELL AVE
Provider Second Line Business Practice Location Address:
SUITE B-5
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-916-5496
Provider Business Practice Location Address Fax Number:
203-265-1216
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-213-9987

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  001882 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 000823 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12094074 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004235918 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018781 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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