1811057847 NPI number — MRS. ANITA LOUISE COOLEY LCSW, LADC

Table of content: AMITABEN J MEHTA (NPI 1962904284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811057847 NPI number — MRS. ANITA LOUISE COOLEY LCSW, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOLEY
Provider First Name:
ANITA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LADC
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:
1811057847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
897 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER FOXCROFT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04426-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-564-4276
Provider Business Mailing Address Fax Number:
207-564-4478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER FOXCROFT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04426-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-564-4276
Provider Business Practice Location Address Fax Number:
207-564-4478
Provider Enumeration Date:
12/11/2006

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: 101YA0400X , with the licence number:  LC4122 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LC11761 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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