1184698979 NPI number — MARY R POWELL LICSW

Table of content: MARY R POWELL LICSW (NPI 1184698979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184698979 NPI number — MARY R POWELL LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
MARY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1184698979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 337
Provider Second Line Business Mailing Address:
NEW RIVER HEALTH ASSOCIATION INC
Provider Business Mailing Address City Name:
SCARBRO
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25917-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-469-2905
Provider Business Mailing Address Fax Number:
304-465-5486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 SCARBRO RD
Provider Second Line Business Practice Location Address:
NEW RIVER HEALTH - SCARBRO
Provider Business Practice Location Address City Name:
SCARBRO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25917-8837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-469-2905
Provider Business Practice Location Address Fax Number:
304-465-5486
Provider Enumeration Date:
02/16/2006

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: 104100000X , with the licence number:  DP00208400 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810000553 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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