1891216677 NPI number — CATHERINE M LAWDER LCSW PLLC

Table of content: (NPI 1891216677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891216677 NPI number — CATHERINE M LAWDER LCSW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHERINE M LAWDER LCSW PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891216677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
914 E HIGH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-4850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-282-4998
Provider Business Mailing Address Fax Number:
434-989-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 PARK STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-282-4998
Provider Business Practice Location Address Fax Number:
434-989-0410
Provider Enumeration Date:
06/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LAWDER
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
AUTHORIZED OFFICIAL / PROVIDER
Authorized Official Telephone Number:
434-282-4998

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  094002387 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904002387 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013907302 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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