1457756868 NPI number — MS. JOANNE LAURA MORTIMER M.S., LMHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457756868 NPI number — MS. JOANNE LAURA MORTIMER M.S., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTIMER
Provider First Name:
JOANNE
Provider Middle Name:
LAURA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSKOWITZ
Provider Other First Name:
JOANNE
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457756868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
297 KNOLLWOOD RD.
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10607-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-686-6891
Provider Business Mailing Address Fax Number:
203-344-9104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 KNOLLWOOD RD.
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10607-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-686-6891
Provider Business Practice Location Address Fax Number:
203-344-9104
Provider Enumeration Date:
10/28/2014

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:  003198-1 , 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)





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