1821221987 NPI number — MRS. KRISHNA PAMARTY MSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821221987 NPI number — MRS. KRISHNA PAMARTY MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAMARTY
Provider First Name:
KRISHNA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1821221987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 E WATTLES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48085-3689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-731-0053
Provider Business Mailing Address Fax Number:
313-286-0890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2951, W.GRAND BLVD.
Provider Second Line Business Practice Location Address:
NEW CENTER COMMUNITY MENTAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-961-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2009

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:  6801087673 , 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)