1851300958 NPI number — DR. SUSAN REBECCA UBER

Table of content: DR. SUSAN REBECCA UBER (NPI 1851300958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851300958 NPI number — DR. SUSAN REBECCA UBER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UBER
Provider First Name:
SUSAN
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UBER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851300958
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:
135 CREEK ROW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HADDAM
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06423-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-873-8140
Provider Business Mailing Address Fax Number:
860-343-9144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-3656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-347-4633
Provider Business Practice Location Address Fax Number:
860-343-9144
Provider Enumeration Date:
08/07/2006

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: 103TC0700X , with the licence number:  CT1083 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037247 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: V-316S . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MIS014 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060001083CT01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223412 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 544802 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 040799 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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