1306970223 NPI number — DR. CONSTANCE JEAN CARPENTER-BIXLER PH.D.

Table of content: DR. CONSTANCE JEAN CARPENTER-BIXLER PH.D. (NPI 1306970223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306970223 NPI number — DR. CONSTANCE JEAN CARPENTER-BIXLER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER-BIXLER
Provider First Name:
CONSTANCE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARPENTER-BIXLER
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306970223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 861
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-0861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-297-3097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE 326
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-297-3097
Provider Business Practice Location Address Fax Number:
413-854-6061
Provider Enumeration Date:
03/15/2007

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: 103G00000X , with the licence number:  7168 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110083668A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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