1205904042 NPI number — DEBORAH ADDARIO LICSW

Table of content: DEBORAH ADDARIO LICSW (NPI 1205904042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205904042 NPI number — DEBORAH ADDARIO LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDARIO
Provider First Name:
DEBORAH
Provider Middle Name:
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:
1205904042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
163 WATER ST
Provider Second Line Business Mailing Address:
MARSHALL NEWELL BOATHOUSE
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-778-7433
Provider Business Mailing Address Fax Number:
603-778-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 WATER ST
Provider Second Line Business Practice Location Address:
MARSHALL NEWELL BOATHOUSE
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-778-7433
Provider Business Practice Location Address Fax Number:
603-778-0022
Provider Enumeration Date:
12/01/2006

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: 1041C0700X , with the licence number:  1236 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2091700 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30424780 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Y011369NH01 . This is a "BHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".