1174613467 NPI number — MARGIE W MORTIMER M.A., L.P.C.C.

Table of content: MARGIE W MORTIMER M.A., L.P.C.C. (NPI 1174613467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174613467 NPI number — MARGIE W MORTIMER M.A., L.P.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTIMER
Provider First Name:
MARGIE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C.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:
1174613467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2874 VICTORIA AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45208-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-321-7702
Provider Business Mailing Address Fax Number:
513-321-4703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10979 REED HARTMAN HWY
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-321-7702
Provider Business Practice Location Address Fax Number:
513-321-4703
Provider Enumeration Date:
10/15/2006

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: 101YP2500X , with the licence number:  E2013 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140050555854 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2003888 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: NL724 . This is a "EMPIREBLUECROSSBLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 22000000222923 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5206754 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1-9H5565 . This is a "HORIZON HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22000000222920 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com