1295860880 NPI number — MS. SUSAN E. NEANDER LCSW

Table of content: (NPI 1194209957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295860880 NPI number — MS. SUSAN E. NEANDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEANDER
Provider First Name:
SUSAN
Provider Middle Name:
E.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1295860880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 VIRGINIA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95521-6853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-822-3998
Provider Business Mailing Address Fax Number:
707-822-3998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 CRESCENT WAY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-3998
Provider Business Practice Location Address Fax Number:
707-822-3998
Provider Enumeration Date:
02/22/2007

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:  LCS19870 , 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: LCS198700 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 243296 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CSW198700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10964739 . This is a "CAQH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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