1972569325 NPI number — MS. ELIZABETH MORRISON PETEGORSKY LICSW CEAP LADC

Table of content: MS. ELIZABETH MORRISON PETEGORSKY LICSW CEAP LADC (NPI 1972569325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972569325 NPI number — MS. ELIZABETH MORRISON PETEGORSKY LICSW CEAP LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETEGORSKY
Provider First Name:
ELIZABETH
Provider Middle Name:
MORRISON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW CEAP LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRISON
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW CEAP LADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972569325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 NORTH FARMS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-584-0999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-297-5644
Provider Business Practice Location Address Fax Number:
413-584-9915
Provider Enumeration Date:
04/25/2006

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: 101YA0400X , with the licence number:  1135 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1015429 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P04900 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 56264 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P04900 . This is a "BCBS OUT OF STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56264 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35392 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56264 . This is a "CIGNA BEHAVIORAL HEALTH E" identifier . This identifiers is of the category "OTHER".




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