1114196698 NPI number — CARMEL MARY O'REARDON LCSW

Table of content: CARMEL MARY O'REARDON LCSW (NPI 1114196698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114196698 NPI number — CARMEL MARY O'REARDON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'REARDON
Provider First Name:
CARMEL
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARE
Provider Other First Name:
CORE
Provider Other Middle Name:
COMMUNITY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114196698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2828 BAMMEL LN APT 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77098-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-721-7470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 BAMMEL LN APT 810
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-721-7470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2008

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:  34140 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01411352 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172970907 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172970902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172970903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB122976 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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