1427355965 NPI number — BETSY CALLOMON B.A.

Table of content: BETSY CALLOMON B.A. (NPI 1427355965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427355965 NPI number — BETSY CALLOMON B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLOMON
Provider First Name:
BETSY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.A.
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:
1427355965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 KENSINGTON SQ
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NEW KENSINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15068-6443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-335-9733
Provider Business Mailing Address Fax Number:
724-335-9734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 KENSINGTON SQ
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-6443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-335-9733
Provider Business Practice Location Address Fax Number:
724-335-9734
Provider Enumeration Date:
02/18/2011

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007624160014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184265 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1210 . This is a "CBHNP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 206234 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 424947 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000364 . This is a "CCBHO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 330989 . This is a "VALUE BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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