1942213574 NPI number — LORENE AARON-BRASS LICSW, LMFT

Table of content: LORENE AARON-BRASS LICSW, LMFT (NPI 1942213574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942213574 NPI number — LORENE AARON-BRASS LICSW, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AARON-BRASS
Provider First Name:
LORENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, 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:
1942213574
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:
902 2ND AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JAMES
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56081-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-375-5688
Provider Business Mailing Address Fax Number:
507-375-5688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 7TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JAMES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56081-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-375-5688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

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:  5405 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 475 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 3G885BR . This is a "CONTRACT PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3G886BR . This is a "INDIVIDUAL PROVIDER NUMBE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6263986 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 116473 . This is a "UCARE/BHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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