1366492316 NPI number — MR. LAWRENCE J. COLLURA M.S.W

Table of content: JENNY RICHARDS (NPI 1497395826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366492316 NPI number — MR. LAWRENCE J. COLLURA M.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLURA
Provider First Name:
LAWRENCE
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W
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:
1366492316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 ROCKFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15243-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-221-8106
Provider Business Mailing Address Fax Number:
412-319-0708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 ROCKFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15243-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-221-8106
Provider Business Practice Location Address Fax Number:
412-319-0708
Provider Enumeration Date:
05/11/2006

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:  CW-000224-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 633825 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 550534000 . This is a "SELECT BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 010986 . This is a "CHAMPUS; OPTIONS; TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 462181000 . This is a "MAGELLAN EAP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4610061 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 366207 . This is a "CIGNA EAP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C9998-0 . This is a "VRI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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