1487636411 NPI number — DR. LINDA J PRESTON M.D.

Table of content: SHELLY JENNINGS JARRARD LCSW-A (NPI 1114441037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487636411 NPI number — DR. LINDA J PRESTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
LINDA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487636411
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:
70 MAIN ST
Provider Second Line Business Mailing Address:
NORTHAMPTON HEALTH CENTER
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01062-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-586-8400
Provider Business Mailing Address Fax Number:
413-585-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MAIN ST
Provider Second Line Business Practice Location Address:
NORTHAMPTON HEALTH CENTER
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01062-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-586-8400
Provider Business Practice Location Address Fax Number:
413-585-5435
Provider Enumeration Date:
11/16/2005

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: 207Q00000X , with the licence number:  157480 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157480 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 157480 . This is a "CONNECTICARE, INC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 36837 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5651683 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 710511 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J19337 . This is a "BLUE CROSS BLUE SHIELD,MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3186580 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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