1578923678 NPI number — MRS. KATHERINE BREWER GOODMAN LPC

Table of content: MRS. KATHERINE BREWER GOODMAN LPC (NPI 1578923678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578923678 NPI number — MRS. KATHERINE BREWER GOODMAN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODMAN
Provider First Name:
KATHERINE
Provider Middle Name:
BREWER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BREWER
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
CHARLOTTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578923678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 BUCKLAND HILLS DR
Provider Second Line Business Mailing Address:
APT 12222
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06042-8704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-247-3996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 BUCKLAND HILLS DR
Provider Second Line Business Practice Location Address:
APT 12222
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06042-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-247-3996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2016

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:  002807 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com