1497771133 NPI number — PATRICIA MOLITOR LCSW

Table of content: PATRICIA MOLITOR LCSW (NPI 1497771133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497771133 NPI number — PATRICIA MOLITOR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLITOR
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1497771133
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:
1230 SE MAYNARD RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-6945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-467-7667
Provider Business Mailing Address Fax Number:
919-467-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 SE MAYNARD RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-6945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-467-7667
Provider Business Practice Location Address Fax Number:
919-467-7667
Provider Enumeration Date:
07/14/2006

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:  C002784 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3045876 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1156U . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1156U . This is a "NC HEALTHCHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A850780 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9264218 . This is a "PHCS BEHAVIORAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0001128295 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6002441 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1161531 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A7924 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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