1457414831 NPI number — STEPHEN H DAVIE LCSW-R

Table of content: STEPHEN H DAVIE LCSW-R (NPI 1457414831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457414831 NPI number — STEPHEN H DAVIE LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIE
Provider First Name:
STEPHEN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
M

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:
1457414831
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:
15 BOULEVARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12839-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-747-2994
Provider Business Mailing Address Fax Number:
518-747-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 BOULEVARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12839-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-747-2994
Provider Business Practice Location Address Fax Number:
518-747-2996
Provider Enumeration Date:
12/18/2006

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: 1041C0700X , with the licence number:  PR012566-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TRI-CARE . This is a "12034176" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MVP . This is a "377615" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: VALUE OPTIONS . This is a "476662" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: VALUE OPTIONS . This is a "7340690002" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BCBS OF NE NY . This is a "000403428001" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: FIDELIS . This is a "050721000016" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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