1063503290 NPI number — NADINE M LUPTON L.C.S.W.

Table of content: NADINE M LUPTON L.C.S.W. (NPI 1063503290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063503290 NPI number — NADINE M LUPTON L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUPTON
Provider First Name:
NADINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
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:
1063503290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 GARRISONVILLE RD., SUITE 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-657-1228
Provider Business Mailing Address Fax Number:
540-657-1999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 GARRISONVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-657-1228
Provider Business Practice Location Address Fax Number:
540-657-1999
Provider Enumeration Date:
09/26/2006

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: 1041C0700X , with the licence number:  0904002347 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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