1306951728 NPI number — MR. PAUL MICHAEL SIVERT LCPC

Table of content: PAIGE NADWORNY (NPI 1043879794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306951728 NPI number — MR. PAUL MICHAEL SIVERT LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIVERT
Provider First Name:
PAUL
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
M

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:
1306951728
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:
10806 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
STE 1-B
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-998-9132
Provider Business Mailing Address Fax Number:
410-902-4678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8600 FOUNDRY ST
Provider Second Line Business Practice Location Address:
STE 214 BOX 2011
Provider Business Practice Location Address City Name:
SAVAGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20763-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-362-2221
Provider Business Practice Location Address Fax Number:
301-362-1013
Provider Enumeration Date:
08/19/2006

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: 101YP2500X , with the licence number:  LC0127 , 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: 141883 . This is a "PVPB" identifier . This identifiers is of the category "OTHER".




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