1558680926 NPI number — MARCIA J NETHERLAND MA, NCC, LPC, TF-CBT

Table of content: CRAIG RAYMOND RUGGIERO PT (NPI 1194234591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558680926 NPI number — MARCIA J NETHERLAND MA, NCC, LPC, TF-CBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NETHERLAND
Provider First Name:
MARCIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, NCC, LPC, TF-CBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRIDER
Provider Other First Name:
MARCIA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, NCC, LPC, TF-CBT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558680926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14734 AMBERJACK TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD RANCH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34202-5800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-658-0581
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14734 AMBERJACK TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD RANCH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34202-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-658-0581
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2010

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: 101YP2500X , with the licence number:  PC006365 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2019024180 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102992907 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".