1962848564 NPI number — LAUREN ELIZABETH BARRETT GROSSMAN PSYD, MSED

Table of content: LAUREN ELIZABETH BARRETT GROSSMAN PSYD, MSED (NPI 1962848564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962848564 NPI number — LAUREN ELIZABETH BARRETT GROSSMAN PSYD, MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSSMAN
Provider First Name:
LAUREN
Provider Middle Name:
ELIZABETH BARRETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MSED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARRETT
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962848564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 UNIVERSITY DR
Provider Second Line Business Mailing Address:
PO BOX 850
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
717-531-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-531-6386
Provider Business Practice Location Address Fax Number:
717-531-6491
Provider Enumeration Date:
05/22/2013

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: 103G00000X , with the licence number:  TPS030370 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103G00000X , with the licence number: 28311 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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