1356548499 NPI number — MS. AMENA MACSHEA LCMHC

Table of content: MS. AMENA MACSHEA LCMHC (NPI 1356548499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356548499 NPI number — MS. AMENA MACSHEA LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACSHEA
Provider First Name:
AMENA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
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:
1356548499
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:
PO BOX 74
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTLAND FOUR CORNERS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05049-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-436-2133
Provider Business Mailing Address Fax Number:
802-436-1733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 DENSMORE HILL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTLAND FOUR CORNERS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-436-2133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007

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: 101YM0800X , with the licence number:  068-0000711 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11514819 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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