1366545774 NPI number — MS. C YVONNE MICHELI LCSWC MSW

Table of content: MS. C YVONNE MICHELI LCSWC MSW (NPI 1366545774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366545774 NPI number — MS. C YVONNE MICHELI LCSWC MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHELI
Provider First Name:
C
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC MSW
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:
1366545774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3568
Provider Second Line Business Mailing Address:
65 DUKE ST, #111
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-2578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-257-5750
Provider Business Mailing Address Fax Number:
410-257-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 DUKE ST
Provider Second Line Business Practice Location Address:
KAINE BLDG SUITE 111
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-6128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-257-5750
Provider Business Practice Location Address Fax Number:
410-257-5750
Provider Enumeration Date:
09/07/2006

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:  02826 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 02826 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3711-0001 . This is a "CARE FIRST BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: QD82 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5562091 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3242370 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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