1609099654 NPI number — MRS. SHANA JANINE MISLAK MSW LCSW C CCDC

Table of content: MRS. SHANA JANINE MISLAK MSW LCSW C CCDC (NPI 1609099654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609099654 NPI number — MRS. SHANA JANINE MISLAK MSW LCSW C CCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISLAK
Provider First Name:
SHANA
Provider Middle Name:
JANINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW C CCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
SHANA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609099654
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:
801 CHANCE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREET
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-893-7217
Provider Business Mailing Address Fax Number:
410-893-7217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 CHANCE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STREET
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-7217
Provider Business Practice Location Address Fax Number:
410-893-7217
Provider Enumeration Date:
04/10/2007

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: 101YA0400X , with the licence number:  1142CCDC , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 06960 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2024 www.npivalidator.com