1376521195 NPI number — MRS. MARY CROUSE-NOVAK LCSW

Table of content: MRS. MARY CROUSE-NOVAK LCSW (NPI 1376521195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376521195 NPI number — MRS. MARY CROUSE-NOVAK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROUSE-NOVAK
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1376521195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 MARKET ST
Provider Second Line Business Mailing Address:
SUITE 223
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-6385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-505-1202
Provider Business Mailing Address Fax Number:
570-651-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-6385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-505-1202
Provider Business Practice Location Address Fax Number:
570-651-9250
Provider Enumeration Date:
01/03/2006

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: 101YM0800X , with the licence number:  CW-012345 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: CW-012345 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 162951 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2013061 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7466214 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101561599 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 828889 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000178272 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".




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