1154610848 NPI number — MRS. JENNIFER CHRISTINA CORREA-ELKINS LCSW-C

Table of content: MRS. JENNIFER CHRISTINA CORREA-ELKINS LCSW-C (NPI 1154610848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154610848 NPI number — MRS. JENNIFER CHRISTINA CORREA-ELKINS LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREA-ELKINS
Provider First Name:
JENNIFER
Provider Middle Name:
CHRISTINA
Provider Name Prefix Text:
MRS.
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:
1154610848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 MAIN ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
REISTERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21136-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-833-0581
Provider Business Mailing Address Fax Number:
410-833-8604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-833-0580
Provider Business Practice Location Address Fax Number:
410-833-8604
Provider Enumeration Date:
04/04/2011

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:  15821 , 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: 654033300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000672794 . This is a "OPTUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0009892665 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2182811 . This is a "CIGNA HEALTHSPRING" identifier . This identifiers is of the category "OTHER".
  • Identifier: 302000 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 548306 . This is a "MHN (HEALTHNET)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 600710604 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: K876-0006 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01547398 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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