1316070600 NPI number — MR. SEAN PATRICK GARRED MED LPC CRC

Table of content: MR. SEAN PATRICK GARRED MED LPC CRC (NPI 1316070600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316070600 NPI number — MR. SEAN PATRICK GARRED MED LPC CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRED
Provider First Name:
SEAN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MED LPC CRC
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:
1316070600
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:
150 W DUBOIS AVENUE
Provider Second Line Business Mailing Address:
JUNIATA PLACE SUITE B
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-1967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-375-7090
Provider Business Mailing Address Fax Number:
814-375-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W DUBOIS AVENUE
Provider Second Line Business Practice Location Address:
JUNIATA PLACE
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-7090
Provider Business Practice Location Address Fax Number:
814-375-7940
Provider Enumeration Date:
03/14/2007

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: 103T00000X , with the licence number:  PS007054L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017312240003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 489548 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: GA1341410 . This is a "PREMIER BLUE" identifier . This identifiers is of the category "OTHER".




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