1336202605 NPI number — MR. JAMES FREDRICK KOHL MSSW LCSW C

Table of content: MR. JAMES FREDRICK KOHL MSSW LCSW C (NPI 1336202605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336202605 NPI number — MR. JAMES FREDRICK KOHL MSSW LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHL
Provider First Name:
JAMES
Provider Middle Name:
FREDRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSSW LCSW C
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:
1336202605
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:
210 GOUCHER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURCHVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-734-6505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 SOUTH MAIN STREET STE 1 A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-0995
Provider Business Practice Location Address Fax Number:
410-339-7169
Provider Enumeration Date:
12/18/2006

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: 104100000X , with the licence number:  07144 , 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: 6221437 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58050003 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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