1114412301 NPI number — KATHERINE E LOUTREL LCSW, LCSW-C

Table of content: KATHERINE E LOUTREL LCSW, LCSW-C (NPI 1114412301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114412301 NPI number — KATHERINE E LOUTREL LCSW, LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOUTREL
Provider First Name:
KATHERINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, 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:
LOUTREL
Provider Other First Name:
KAT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, LCSW-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114412301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 CUMBERLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-504-8124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 CUMBERLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-3819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-504-8124
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2018

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:  23875 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW022251 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 698860 . This is a "ADHD- CERTIFIED CLINICAL SPECIALTY PROVIDER" identifier . This identifiers is of the category "OTHER".




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