1063572691 NPI number — MS. MAUREEN MCNAMARA LMSW DCSW

Table of content: AMANDA PUNZENBERGER NP (NPI 1831875277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063572691 NPI number — MS. MAUREEN MCNAMARA LMSW DCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNAMARA
Provider First Name:
MAUREEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW DCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILKELLY
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063572691
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:
1520 TEXEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-660-3905
Provider Business Mailing Address Fax Number:
269-660-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 W MANCHESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-660-3905
Provider Business Practice Location Address Fax Number:
269-660-3899
Provider Enumeration Date:
12/12/2006

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:  6801034386 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 172774 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5821754 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6274622 . This is a "PHP IBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP294508 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0890246 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126312 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5821754 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6274622 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27087 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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