1104998491 NPI number — MR. GARY W MESSECAR LCSW

Table of content: MR. GARY W MESSECAR LCSW (NPI 1104998491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104998491 NPI number — MR. GARY W MESSECAR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESSECAR
Provider First Name:
GARY
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1104998491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 SHADY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVENTRY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06238-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-742-5874
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 HARTFORD TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-533-1070
Provider Business Practice Location Address Fax Number:
860-533-1070
Provider Enumeration Date:
11/14/2006

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: 104100000X , with the licence number:  000586 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com