1982748927 NPI number — JANYCE G KITTLER LICSW

Table of content: JANYCE G KITTLER LICSW (NPI 1982748927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982748927 NPI number — JANYCE G KITTLER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITTLER
Provider First Name:
JANYCE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1982748927
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:
24 BLACK POND HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02061-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-659-4807
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 TOTMAN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-7564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-968-4059
Provider Business Practice Location Address Fax Number:
617-471-6327
Provider Enumeration Date:
02/15/2007

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:  1030336 , 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: 738 . This is a "LADC 1 LIC ALC & DRUG COU" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2237294 . This is a "FIRST HEALTH ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP2178814 . This is a "HARVARD PILGRIM PROV ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PO8560 . This is a "BLUE CROSS BLUE SHIELD PR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030336 . This is a "LICSW" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 494997 . This is a "TUFTS HEALTH PLAN PROV ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11522997 . This is a "CAQH ID #" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com