1639481633 NPI number — KAREN HOLCOMB LSW

Table of content: KAREN HOLCOMB LSW (NPI 1639481633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639481633 NPI number — KAREN HOLCOMB LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLCOMB
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
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:
1639481633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1385 POCONO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT POCONO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18344-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-476-7704
Provider Business Mailing Address Fax Number:
570-421-3600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 3RD AVE STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-243-9036
Provider Business Practice Location Address Fax Number:
570-288-0508
Provider Enumeration Date:
07/07/2010

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 132189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SW132189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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