1134269210 NPI number — GEORGIA G HYNES CCDP,CCS,CAC,NCACII

Table of content: GEORGIA G HYNES CCDP,CCS,CAC,NCACII (NPI 1134269210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134269210 NPI number — GEORGIA G HYNES CCDP,CCS,CAC,NCACII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYNES
Provider First Name:
GEORGIA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCDP,CCS,CAC,NCACII
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:
1134269210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 TITUS RD
Provider Second Line Business Mailing Address:
P.O. BOX 560
Provider Business Mailing Address City Name:
WASHINGTON DEPOT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06794-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-868-0857
Provider Business Mailing Address Fax Number:
860-868-1288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 TITUS RD
Provider Second Line Business Practice Location Address:
BOX 560
Provider Business Practice Location Address City Name:
WASHINGTON DEPOT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06794-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-868-0857
Provider Business Practice Location Address Fax Number:
860-868-1288
Provider Enumeration Date:
02/07/2007

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: 101YA0400X , with the licence number:  000322 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 000322 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NCACII -004029 . This is a "NAADAC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 000322 . This is a "STATE OF CT DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CCS-1410 . This is a "CONNECTICUT CERTIFICATION BOARD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CAC-4490 . This is a "NEW YORK STATE OASAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CAC-1410 . This is a "CONNECTICUT CERTIFICATION BOARD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CCDP-1410 . This is a "CONNECTICUT CERTIFICATION BOARD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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