1720314263 NPI number — LORRAINE DIANE MCCANN LMHC

Table of content: LORRAINE DIANE MCCANN LMHC (NPI 1720314263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720314263 NPI number — LORRAINE DIANE MCCANN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANN
Provider First Name:
LORRAINE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCANN
Provider Other First Name:
LORRIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720314263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3060 TAMIAMI TRL N
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34103-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-273-1119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3060 TAMIAMI TRL N
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-273-1119
Provider Business Practice Location Address Fax Number:
239-591-2706
Provider Enumeration Date:
10/18/2009

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: 101YM0800X , with the licence number:  MH7000 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z032G . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".