1982642575 NPI number — MARILYN PAGETT LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982642575 NPI number — MARILYN PAGETT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGETT
Provider First Name:
MARILYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BABULA
Provider Other First Name:
MARILYN
Provider Other Middle Name:
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:
1982642575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 BLUEBERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANNANOA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28778-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-686-5468
Provider Business Mailing Address Fax Number:
828-225-4822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 PATTON AVE STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28806-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-225-4980
Provider Business Practice Location Address Fax Number:
828-225-4822
Provider Enumeration Date:
06/03/2006

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:  C004186 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 136F1 . This is a "BCBSNC GRP # 015HF" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6002987 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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