1093844458 NPI number — SUSAN PARKHILL MACVEAN LCSW-C

Table of content: SUSAN PARKHILL MACVEAN LCSW-C (NPI 1093844458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093844458 NPI number — SUSAN PARKHILL MACVEAN LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACVEAN
Provider First Name:
SUSAN
Provider Middle Name:
PARKHILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
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:
1093844458
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:
600 RIDGELY AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-571-6780
Provider Business Mailing Address Fax Number:
410-349-3346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 RIDGELY AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-571-6780
Provider Business Practice Location Address Fax Number:
410-349-3346
Provider Enumeration Date:
03/03/2007

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: 1041C0700X , with the licence number:  08551 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: XXXXX7188 21401 000 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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