1235160243 NPI number — MARY PAT FEENEY SR. LCSW RN

Table of content: MARY PAT FEENEY SR. LCSW RN (NPI 1235160243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235160243 NPI number — MARY PAT FEENEY SR. LCSW RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEENEY
Provider First Name:
MARY PAT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
LCSW RN
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:
1235160243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11583 C AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95603-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-823-1629
Provider Business Mailing Address Fax Number:
530-885-7714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
853 LINCOLN WAY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-823-1629
Provider Business Practice Location Address Fax Number:
530-885-7714
Provider Enumeration Date:
07/06/2006

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: 174400000X , with the licence number:  LCS18352 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 159791 . This is a "COM PSTCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 222015 . This is a "MHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3983 . This is a "CONCERN EAP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6236927 . This is a "USBH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CWS183520 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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