1639126097 NPI number — CELESTE V REED HANISH LCSW

Table of content: CELESTE V REED HANISH LCSW (NPI 1639126097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639126097 NPI number — CELESTE V REED HANISH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED HANISH
Provider First Name:
CELESTE
Provider Middle Name:
V
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:
1639126097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 SUMMER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPDEN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04444-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-478-1562
Provider Business Mailing Address Fax Number:
207-862-5393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-478-1562
Provider Business Practice Location Address Fax Number:
207-862-5393
Provider Enumeration Date:
05/30/2006

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: 104100000X , with the licence number:  LC6917 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 098304 . This is a "ANTHEM LEGACY NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com