1467580175 NPI number — ANDREA MAITINSKY KEINS PH.D. PSYCHOLOGIST

Table of content: ANDREA MAITINSKY KEINS PH.D. PSYCHOLOGIST (NPI 1467580175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467580175 NPI number — ANDREA MAITINSKY KEINS PH.D. PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAITINSKY KEINS
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D. PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEINS
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D. PSYCHOLOGIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467580175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01059-9627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-237-0086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 N PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-237-0086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2007

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1300881 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0300050 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".