1265951628 NPI number — EMBRACE THE CHANGE COUNSELING

Table of content: (NPI 1265951628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265951628 NPI number — EMBRACE THE CHANGE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRACE THE CHANGE COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265951628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 W CHESTNUT HILL RD STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-358-6237
Provider Business Mailing Address Fax Number:
888-358-6570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 W CHESTNUT HILL RD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-358-6237
Provider Business Practice Location Address Fax Number:
888-358-6570
Provider Enumeration Date:
09/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOSO
Authorized Official First Name:
LUZ DEL ALBA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN. AND MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
302-358-6570

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1003104902 . This is a "MENTAL HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com