1902823412 NPI number — MRS. JOANNA RUTH DURHAM LCSW C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902823412 NPI number — MRS. JOANNA RUTH DURHAM LCSW C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DURHAM

Provider First Name:

JOANNA

Provider Middle Name:

RUTH

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

LCSW C

Provider Gender Code:

F

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:

1902823412

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/06/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3691 PARK AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ELLICOTT CITY

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21043-4783

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-456-7022

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

3691 PARK AVE

Provider Second Line Business Practice Location Address:

SUITE 2

Provider Business Practice Location Address City Name:

ELLICOTT CITY

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21043-4783

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-456-7022

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  09934 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0022 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
• Identifier: 150N . This is a "MBMD" identifier . This identifiers is of the category "OTHER".
• Identifier: 360218 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
• Identifier: 331945 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
• Identifier: 593795443 . This is a "MAMS" identifier . This identifiers is of the category "OTHER".
• Identifier: 223634 . This is a "COMP" identifier . This identifiers is of the category "OTHER".
• Identifier: 252450 . This is a "COMP" identifier . This identifiers is of the category "OTHER".
• Identifier: 61766403 . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
• Identifier: 705BPS . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
• Identifier: K452 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
• Identifier: 150N133G . This is a "MBMD" identifier . This identifiers is of the category "OTHER".
• Identifier: 100033364 . This is a "APS" identifier . This identifiers is of the category "OTHER".
• Identifier: 226106 . This is a "KAIS" identifier . This identifiers is of the category "OTHER".
• Identifier: 266715000 . This is a "MAGE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2131895 . This is a "MAMS" identifier . This identifiers is of the category "OTHER".
• Identifier: 790298000 . This is a "MAGE" identifier . This identifiers is of the category "OTHER".