1457380396 NPI number — MS. SHEILA D RENAUD FINNEGAN LICSW

Table of content: MS. SHEILA D RENAUD FINNEGAN LICSW (NPI 1457380396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457380396 NPI number — MS. SHEILA D RENAUD FINNEGAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENAUD FINNEGAN
Provider First Name:
SHEILA
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1457380396
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:
1361 ELM ST SUITE 407
Provider Second Line Business Mailing Address:
GREEN HOUSE GROUP
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-3050
Provider Business Mailing Address Fax Number:
603-668-8666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1361 ELM ST SUITE 407
Provider Second Line Business Practice Location Address:
GREEN HOUSE GROUP
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-3050
Provider Business Practice Location Address Fax Number:
603-668-8666
Provider Enumeration Date:
07/02/2006

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:  46 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1401231Y0NH02 . This is a "ANTHEM PRIVATE PRACTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1401231Y0NH01 . This is a "ANTHEM GREEN HOUSE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30007773 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033352 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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