1225656473 NPI number — MR. KENNETH JULIAN TOUSSAINT LMSW

Table of content: MR. KENNETH JULIAN TOUSSAINT LMSW (NPI 1225656473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225656473 NPI number — MR. KENNETH JULIAN TOUSSAINT LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOUSSAINT
Provider First Name:
KENNETH
Provider Middle Name:
JULIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOUSSAINT
Provider Other First Name:
KENNETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225656473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 FULLER TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07050-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-809-4716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 FULLER TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07050-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-809-4716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2020

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: 104100000X , with the licence number:  059257 , 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)





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