1184814261 NPI number — MRS. REBECCA BERKOWITZ NUTTING LMSW

Table of content: MRS. REBECCA BERKOWITZ NUTTING LMSW (NPI 1184814261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184814261 NPI number — MRS. REBECCA BERKOWITZ NUTTING LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUTTING
Provider First Name:
REBECCA
Provider Middle Name:
BERKOWITZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERKOWITZ
Provider Other First Name:
REBECCA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184814261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 WESTBURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49006-2662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-468-1831
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 W PATERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49007-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-349-2641
Provider Business Practice Location Address Fax Number:
269-488-0817
Provider Enumeration Date:
07/26/2007

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: 1041C0700X , with the licence number:  6801091006 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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