1003914672 NPI number — MS. KARYN ANNE LEIPOLD MSW LCSW CADC

Table of content: MS. KARYN ANNE LEIPOLD MSW LCSW CADC (NPI 1003914672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003914672 NPI number — MS. KARYN ANNE LEIPOLD MSW LCSW CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIPOLD
Provider First Name:
KARYN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW CADC
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:
1003914672
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:
69B NORTH MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEEP RIVER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-395-8410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 WESTBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESSEX
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-767-0147
Provider Business Practice Location Address Fax Number:
860-767-0148
Provider Enumeration Date:
09/20/2006

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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