1336232115 NPI number — KAREN ANGELA LAKE-SHAMPAIN L.C.S.W.

Table of content: AHEEMA GAZI D.O. (NPI 1023863313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336232115 NPI number — KAREN ANGELA LAKE-SHAMPAIN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKE-SHAMPAIN
Provider First Name:
KAREN
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
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:
1336232115
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:
301 EAST COOK STREET
Provider Second Line Business Mailing Address:
SUITE B2
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-614-6221
Provider Business Mailing Address Fax Number:
805-614-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 EAST COOK STREET
Provider Second Line Business Practice Location Address:
SUITE B2
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-614-6221
Provider Business Practice Location Address Fax Number:
805-614-0530
Provider Enumeration Date:
10/02/2006

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:  LCS15650 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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