1952360232 NPI number — SHAWNE D. DIAZ LPC

Table of content: TERRY LYNN CONRAD (NPI 1518621309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952360232 NPI number — SHAWNE D. DIAZ LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
SHAWNE
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1952360232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
785 5TH AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-263-9555
Provider Business Mailing Address Fax Number:
717-709-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
964 ISABEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-7482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-274-9777
Provider Business Practice Location Address Fax Number:
717-274-9815
Provider Enumeration Date:
03/23/2006

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: 101YM0800X , with the licence number:  PC010078 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 387279 . This is a "MVP PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 14Y007926NH01 . This is a "ANTHEM ACES #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30423181 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103760175 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11362913 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2153905 . This is a "CIGNA BH PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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