1326007923 NPI number — EILEEN NATAL SCHNEIDER LCSW

Table of content: EILEEN NATAL SCHNEIDER LCSW (NPI 1326007923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326007923 NPI number — EILEEN NATAL SCHNEIDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
EILEEN
Provider Middle Name:
NATAL
Provider Name Prefix Text:
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:
1326007923
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:
2000 FRONTIS PLAZA BLVD STE 200
Provider Second Line Business Mailing Address:
(ATTN) FORSYTH MEDICAL GROUP
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-2435
Provider Business Mailing Address Fax Number:
336-277-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 CHARLOIS BLVD
Provider Second Line Business Practice Location Address:
DBA WINSTON-SALEM HEALTHCARE
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-1004
Provider Business Practice Location Address Fax Number:
336-718-1061
Provider Enumeration Date:
03/22/2006

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: 1041C0700X , with the licence number:  C001075 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890294Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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