1528071875 NPI number — REBECCA R MAGEE LCSW

Table of content: REBECCA R MAGEE LCSW (NPI 1528071875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528071875 NPI number — REBECCA R MAGEE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGEE
Provider First Name:
REBECCA
Provider Middle Name:
R
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:
1528071875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MEDICAL DR
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-788-0092
Provider Business Mailing Address Fax Number:
757-788-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-788-0200
Provider Business Practice Location Address Fax Number:
757-788-0950
Provider Enumeration Date:
08/15/2006

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:  0904001095 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4945773 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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