1730289901 NPI number — MR. BERNARD ALAN SLUTSKY M.A. LICSW

Table of content: MR. BERNARD ALAN SLUTSKY M.A. LICSW (NPI 1730289901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730289901 NPI number — MR. BERNARD ALAN SLUTSKY M.A. LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLUTSKY
Provider First Name:
BERNARD
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A. LICSW
Provider Gender Code:
M

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:
1730289901
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:
7225 FORESTVIEW LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-541-8176
Provider Business Mailing Address Fax Number:
763-201-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7225 FORESTVIEW LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-541-8176
Provider Business Practice Location Address Fax Number:
763-201-1095
Provider Enumeration Date:
09/25/2006

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:  02932 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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