1699807941 NPI number — MRS. LUCI BOOTH BEATTIE MSW LISW

Table of content: MRS. LUCI BOOTH BEATTIE MSW LISW (NPI 1699807941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699807941 NPI number — MRS. LUCI BOOTH BEATTIE MSW LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTIE
Provider First Name:
LUCI
Provider Middle Name:
BOOTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW
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:
1699807941
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:
14322 THATCHERS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRONGSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-572-9128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20325 CENTER RIDGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 628
Provider Business Practice Location Address City Name:
ROCKY RIVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-331-5570
Provider Business Practice Location Address Fax Number:
440-331-3221
Provider Enumeration Date:
03/12/2007

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: 104100000X , with the licence number:  I5971 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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