1710127444 NPI number — ANNIE ROSEANNA SMALL LMHC INTERN

Table of content: ANNIE ROSEANNA SMALL LMHC INTERN (NPI 1710127444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710127444 NPI number — ANNIE ROSEANNA SMALL LMHC INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMALL
Provider First Name:
ANNIE
Provider Middle Name:
ROSEANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC INTERN
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:
1710127444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WORCESTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02139-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-945-9331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SACRAMENTO ST.
Provider Second Line Business Practice Location Address:
THE GUIDANCE CENTER, INC.
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-354-2275
Provider Business Practice Location Address Fax Number:
617-547-4356
Provider Enumeration Date:
02/20/2009

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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