1336573195 NPI number — MS. ANDREA DENSTON DEPRIMA LCSW-C

Table of content: MS. ANDREA DENSTON DEPRIMA LCSW-C (NPI 1336573195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336573195 NPI number — MS. ANDREA DENSTON DEPRIMA LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPRIMA
Provider First Name:
ANDREA
Provider Middle Name:
DENSTON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENSTON
Provider Other First Name:
ANDREA
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336573195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21802-1978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1015
Provider Business Mailing Address Fax Number:
410-749-0654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1813 SWEETBAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-219-5483
Provider Business Practice Location Address Fax Number:
410-219-5486
Provider Enumeration Date:
08/29/2013

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:  13842 , 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: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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