1013057132 NPI number — DR. BARBARA TERRY KREEDMAN PH.D.

Table of content: DR. BARBARA TERRY KREEDMAN PH.D. (NPI 1013057132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013057132 NPI number — DR. BARBARA TERRY KREEDMAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREEDMAN
Provider First Name:
BARBARA
Provider Middle Name:
TERRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1013057132
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:
73725 EL PASEO
Provider Second Line Business Mailing Address:
SUITE 23-D
Provider Business Mailing Address City Name:
PALM DESERT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92260-4311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-340-1114
Provider Business Mailing Address Fax Number:
760-328-4261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73725 EL PASEO
Provider Second Line Business Practice Location Address:
SUITE 23-D
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-340-1114
Provider Business Practice Location Address Fax Number:
760-328-4261
Provider Enumeration Date:
02/07/2007

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: 101YM0800X , with the licence number:  LCSW, LCS 6133 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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