1063586873 NPI number — M. KATRINE HUGHES LICSW/LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063586873 NPI number — M. KATRINE HUGHES LICSW/LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
M.
Provider Middle Name:
KATRINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW/LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGHES
Provider Other First Name:
MARY
Provider Other Middle Name:
KATRINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW/LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063586873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JACKSON HTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-770-8777
Provider Business Mailing Address Fax Number:
877-501-7757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-770-8777
Provider Business Practice Location Address Fax Number:
877-501-7757
Provider Enumeration Date:
11/20/2006

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: 1041C0700X , with the licence number:  LCS13972 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 089.0059210 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0021366 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1019159 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: CSW139721 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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