1740319342 NPI number — MARYRITA CHIMOVITZ LMSW, ACSW, CAC I

Table of content: (NPI 1306476809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740319342 NPI number — MARYRITA CHIMOVITZ LMSW, ACSW, CAC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIMOVITZ
Provider First Name:
MARYRITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW, ACSW, CAC I
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:
1740319342
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:
2383 MARGARET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FENTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48430-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-629-0172
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6379 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48722-9566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-777-4357
Provider Business Practice Location Address Fax Number:
989-777-7257
Provider Enumeration Date:
03/02/2007

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:  6801070050 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01003253 . This is a "HEALTH PLUS - BRIDGEPORT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0996911 . This is a "HEALTH PLUS - SAGINAW" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com