1225170913 NPI number — ERIN JACARUSO LEVENTHAL MA, CCC-SLP

Table of content: ERIN JACARUSO LEVENTHAL MA, CCC-SLP (NPI 1225170913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225170913 NPI number — ERIN JACARUSO LEVENTHAL MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVENTHAL
Provider First Name:
ERIN
Provider Middle Name:
JACARUSO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
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:
1225170913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 CAROLINA ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-370-4070
Provider Business Mailing Address Fax Number:
336-370-9008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 CAROLINA ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-370-4070
Provider Business Practice Location Address Fax Number:
336-370-9008
Provider Enumeration Date:
02/12/2007

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: 235Z00000X , with the licence number:  5880 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7412056 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135HR . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 186373 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com