1689850174 NPI number — MS. JENNIFER HUDSON GOSCINSKI MSW, LCSW

Table of content: MS. JENNIFER HUDSON GOSCINSKI MSW, LCSW (NPI 1689850174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689850174 NPI number — MS. JENNIFER HUDSON GOSCINSKI MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSCINSKI
Provider First Name:
JENNIFER
Provider Middle Name:
HUDSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, 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:
1689850174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KITTY HAWK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27949-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-489-9127
Provider Business Mailing Address Fax Number:
252-480-3127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7531 S VIRGINIA DARE TRL
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
NAGS HEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27959-9162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-489-9127
Provider Business Practice Location Address Fax Number:
252-480-3127
Provider Enumeration Date:
01/14/2008

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: 1041C0700X , with the licence number:  C005915 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6106866 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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