1235283862 NPI number — MRS. HOLLY ROGERS BRISCOE LCSW-C

Table of content: MRS. HOLLY ROGERS BRISCOE LCSW-C (NPI 1235283862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235283862 NPI number — MRS. HOLLY ROGERS BRISCOE LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISCOE
Provider First Name:
HOLLY
Provider Middle Name:
ROGERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
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:
1235283862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 555
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-0555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-5425
Provider Business Mailing Address Fax Number:
410-535-5489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 DUKE STREET
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-5425
Provider Business Practice Location Address Fax Number:
410-535-5489
Provider Enumeration Date:
01/22/2007

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: 1041C0700X , with the licence number:  09134 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2641 . This is a "GHMSI & FEDERAL BLUE CROS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 363551 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: QC93 . This is a "CAREFIRST BLUE CROSS BLUE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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