1992908362 NPI number — MS. MARY M LAING LMFT,LICSW,RN

Table of content: MS. MARY M LAING LMFT,LICSW,RN (NPI 1992908362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992908362 NPI number — MS. MARY M LAING LMFT,LICSW,RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAING
Provider First Name:
MARY
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT,LICSW,RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KINGSTON
Provider Other First Name:
MARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992908362
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:
16817 UPPER 20TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55043-9416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-491-4805
Provider Business Mailing Address Fax Number:
651-578-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6053 HUDSON RD
Provider Second Line Business Practice Location Address:
SUITE 192
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-491-4805
Provider Business Practice Location Address Fax Number:
651-578-0021
Provider Enumeration Date:
06/06/2007

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:  7805 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 739 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2024 www.npivalidator.com