1467411207 NPI number — ALIX STOCKWOOD LICSW

Table of content: ALIX STOCKWOOD LICSW (NPI 1467411207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467411207 NPI number — ALIX STOCKWOOD LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKWOOD
Provider First Name:
ALIX
Provider Middle Name:
Provider Name Prefix Text:
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:
1467411207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-480-3434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-480-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2006

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:  ISW00253 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 1017953 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1029030 . This is a "NHP/BEACON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6230482 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS19612 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23622-9 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 409254 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".




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