1356499479 NPI number — ELAINE MARONICK ELAINE MARONICK

Table of content: ELAINE MARONICK ELAINE MARONICK (NPI 1356499479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356499479 NPI number — ELAINE MARONICK ELAINE MARONICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARONICK
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ELAINE MARONICK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARONICK
Provider Other First Name:
ELAINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356499479
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:
7 W 6TH AVE
Provider Second Line Business Mailing Address:
SUITE 512
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59601-5072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-442-9270
Provider Business Mailing Address Fax Number:
406-447-4255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 W 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-442-9270
Provider Business Practice Location Address Fax Number:
406-447-4255
Provider Enumeration Date:
01/08/2007

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: 101YP2500X , with the licence number:  663 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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