1285874016 NPI number — SCHOOL BASED MENTAL HEALTH PROGRAM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285874016 NPI number — SCHOOL BASED MENTAL HEALTH PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL BASED MENTAL HEALTH PROGRAM
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:
1285874016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64 NEW YORK AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20002-3320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-673-7013
Provider Business Mailing Address Fax Number:
202-673-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 NEW YORK AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20002-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-673-7013
Provider Business Practice Location Address Fax Number:
202-673-7502
Provider Enumeration Date:
03/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORMAN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
WHITE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
202-673-7013

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LC302454 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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