1376979856 NPI number — CRESCENT L CLARKSON MSW

Table of content: CRESCENT L CLARKSON MSW (NPI 1376979856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376979856 NPI number — CRESCENT L CLARKSON MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARKSON
Provider First Name:
CRESCENT
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1376979856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 REHILL AVE
Provider Second Line Business Mailing Address:
EMERGENCY ROOM SOMERSET MEDICAL CENTER
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-526-4100
Provider Business Mailing Address Fax Number:
908-526-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 WARREN ST
Provider Second Line Business Practice Location Address:
HUMAN SERVICES P.E.S.S.
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-231-6475
Provider Business Practice Location Address Fax Number:
908-526-0536
Provider Enumeration Date:
09/17/2013

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: 104100000X , with the licence number:  44SL04855200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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