1326039041 NPI number — MS. HATTIE ANNA PETERSON MSW, LICSW

Table of content: MS. HATTIE ANNA PETERSON MSW, LICSW (NPI 1326039041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326039041 NPI number — MS. HATTIE ANNA PETERSON MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
HATTIE
Provider Middle Name:
ANNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIRSCHNER
Provider Other First Name:
GORDON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326039041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 GARRISON ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20008-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-966-1876
Provider Business Mailing Address Fax Number:
202-362-2029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 GARRISON ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20008-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-966-1876
Provider Business Practice Location Address Fax Number:
202-966-1876
Provider Enumeration Date:
11/02/2005

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

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

  • Identifier: 1326039041 . This is a "NPI" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".