1912985458 NPI number — MS. ANITA M MENDES LICSW

Table of content: MS. ANITA M MENDES LICSW (NPI 1912985458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912985458 NPI number — MS. ANITA M MENDES LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDES
Provider First Name:
ANITA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1912985458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03449-0212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-525-3454
Provider Business Mailing Address Fax Number:
603-525-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 CONCORD STREET
Provider Second Line Business Practice Location Address:
160
Provider Business Practice Location Address City Name:
PETERBOROUGH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03458-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-525-3454
Provider Business Practice Location Address Fax Number:
603-525-3454
Provider Enumeration Date:
01/05/2006

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: 1041C0700X , with the licence number:  464 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1040086 . This is a "HCVM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 412056751 . This is a "HARVARD PILG/PACIFICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 220649741 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 458185 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 9R0183 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1405573Y0NH02 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 412056751 . This is a "GREAT WEST" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 463366 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 477489000 . This is a "MEGELLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 412056751-002 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 03422476 . This is a "TRI-CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1040886 . This is a "CIGNA BEHAV. HEALTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 213591 . This is a "COMPPSYCH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30422476 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412056751 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 550010007027 . This is a "PACIFICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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