1063622348 NPI number — DR. BRENDA PAPINCAK LOREN PH.D.

Table of content: DR. BRENDA PAPINCAK LOREN PH.D. (NPI 1063622348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063622348 NPI number — DR. BRENDA PAPINCAK LOREN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOREN
Provider First Name:
BRENDA
Provider Middle Name:
PAPINCAK
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:
1063622348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 BURNET AVE
Provider Second Line Business Mailing Address:
3 SOUTH CREDENTIALING
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-585-5503
Provider Business Mailing Address Fax Number:
513-585-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 GALBRAITH ROAD
Provider Second Line Business Practice Location Address:
DRAKE CENTER, DEPT. MED. PSYCHOLOGY & NEUROPSYCHOLOGY
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45216-1096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-418-2608
Provider Business Practice Location Address Fax Number:
513-418-2618
Provider Enumeration Date:
05/23/2007

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: 103TC0700X , with the licence number:  6281 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 1915 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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