1750420923 NPI number — LINDY HEWITT LINDY HEWITT MFT

Table of content: MS. JEANNETTE T CARTER LCAS (NPI 1720735491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750420923 NPI number — LINDY HEWITT LINDY HEWITT MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEWITT
Provider First Name:
LINDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LINDY HEWITT MFT
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:
1750420923
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:
205 E 3RD AVE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94401-4051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-558-0592
Provider Business Mailing Address Fax Number:
650-685-8179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94401-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-558-0592
Provider Business Practice Location Address Fax Number:
650-685-8179
Provider Enumeration Date:
02/05/2007

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: 101YM0800X , with the licence number:  MFC39521 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80541 . This is a "PROVIDER NUMBER MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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