1225651946 NPI number — ELIZABETH MARIE EGGLESTON LCSW, CASAC II

Table of content: ELIZABETH MARIE EGGLESTON LCSW, CASAC II (NPI 1225651946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225651946 NPI number — ELIZABETH MARIE EGGLESTON LCSW, CASAC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGLESTON
Provider First Name:
ELIZABETH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CASAC II
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:
1225651946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ST JOSEPH'S ADDICTION TREATMENT AND RECOVERY CENTERS
Provider Second Line Business Mailing Address:
458 EAST MAIN ST
Provider Business Mailing Address City Name:
MALONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-319-2388
Provider Business Mailing Address Fax Number:
518-481-4213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
458 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-319-2388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2020

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:  103890 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com