1326367855 NPI number — TRICIA KARVOUNIS LICSW, LCSW

Table of content: (NPI 1235641523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326367855 NPI number — TRICIA KARVOUNIS LICSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARVOUNIS
Provider First Name:
TRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, LCSW
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:
1326367855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/27/2012
NPI Reactivation Date:
04/23/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8570 GRANITE CT STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-4240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-310-4646
Provider Business Mailing Address Fax Number:
239-256-7516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8570 GRANITE CT STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33908-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-310-4646
Provider Business Practice Location Address Fax Number:
239-256-7516
Provider Enumeration Date:
05/24/2010

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:  115214 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LC13422 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 17575 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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