1518427319 NPI number — JOSEPH S PUNTASECCA LCSW, LMSW

Table of content: JOSEPH S PUNTASECCA LCSW, LMSW (NPI 1518427319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518427319 NPI number — JOSEPH S PUNTASECCA LCSW, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUNTASECCA
Provider First Name:
JOSEPH
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LMSW
Provider Gender Code:
M

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:
1518427319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
934 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-7135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-773-7060
Provider Business Mailing Address Fax Number:
801-366-1787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
934 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-7060
Provider Business Practice Location Address Fax Number:
801-366-1787
Provider Enumeration Date:
03/20/2019

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: 104100000X , with the licence number:  11548679-3502 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 11548679-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108310-01 . This is a "LMSW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com