1720397573 NPI number — MRS. CHRISTEN NOEL CORREIRA MSW, LICSW

Table of content: MRS. CHRISTEN NOEL CORREIRA MSW, LICSW (NPI 1720397573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720397573 NPI number — MRS. CHRISTEN NOEL CORREIRA MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREIRA
Provider First Name:
CHRISTEN
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYNCH
Provider Other First Name:
CHRISTEN
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720397573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 LONG POND RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-2662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-844-4410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 LONG POND RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-844-4410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2010

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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