1437161585 NPI number — MS. KATHERINE BLAIR WISSMAN LSCW-C

Table of content: MS. KATHERINE BLAIR WISSMAN LSCW-C (NPI 1437161585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437161585 NPI number — MS. KATHERINE BLAIR WISSMAN LSCW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISSMAN
Provider First Name:
KATHERINE
Provider Middle Name:
BLAIR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSCW-C
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:
1437161585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6123 MONTROSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-838-4200
Provider Business Mailing Address Fax Number:
301-309-2596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6123 MONTROSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-881-3700
Provider Business Practice Location Address Fax Number:
301-468-1862
Provider Enumeration Date:
08/13/2006

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: 104100000X , with the licence number:  12093 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 403337000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 622642 01 . This is a "BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 236676 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 589530000 . This is a "MAGELLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7134551 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: A2840130 . This is a "BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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