1356613210 NPI number — ABBEYFIELD PSYCHOTHERAPY INC

Table of content: (NPI 1356613210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356613210 NPI number — ABBEYFIELD PSYCHOTHERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBEYFIELD PSYCHOTHERAPY INC
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:
1356613210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5479 E ABBEYFIELD ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90815-3050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-498-5900
Provider Business Mailing Address Fax Number:
562-498-5909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5479 E ABBEYFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-498-5900
Provider Business Practice Location Address Fax Number:
562-498-5909
Provider Enumeration Date:
02/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BENEDICT
Authorized Official First Name:
TAMERA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
562-498-5900

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LCS27670 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY19703 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS19542 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS18360 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS25775 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS21429 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC43055 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC46641 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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