1992823132 NPI number — PAMELA KOSSEFF MSW

Table of content: PAMELA KOSSEFF MSW (NPI 1992823132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992823132 NPI number — PAMELA KOSSEFF MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSSEFF
Provider First Name:
PAMELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1992823132
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:
37 POWEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02840-2676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-847-1723
Provider Business Mailing Address Fax Number:
401-846-9868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 POWEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02840-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-847-1723
Provider Business Practice Location Address Fax Number:
401-846-9868
Provider Enumeration Date:
03/26/2007

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:  ISW00601 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000009437-001 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".