1902168115 NPI number — IRENE SHERLOCK LMFT

Table of content: IRENE SHERLOCK LMFT (NPI 1902168115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902168115 NPI number — IRENE SHERLOCK LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERLOCK
Provider First Name:
IRENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1902168115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 OLD RIDGEBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810-5128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-792-4515
Provider Business Mailing Address Fax Number:
203-748-2632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 OLD RIDGEBURY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-5128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-792-4515
Provider Business Practice Location Address Fax Number:
203-748-2632
Provider Enumeration Date:
06/13/2012

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: 106H00000X , with the licence number:  001524 , 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: 008031626 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004123840 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008017939 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".