1447463849 NPI number — MRS. MAUREEN CATHERINE EVERETTE M.A.,L.M.H.C.

Table of content: LADAWN EMERY PLPC (NPI 1568978302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447463849 NPI number — MRS. MAUREEN CATHERINE EVERETTE M.A.,L.M.H.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVERETTE
Provider First Name:
MAUREEN
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.,L.M.H.C.
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:
1447463849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 MALIBU LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIALANTIC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-777-6318
Provider Business Mailing Address Fax Number:
321-777-2178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3270 SUNTREE BLVD.
Provider Second Line Business Practice Location Address:
#109
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-751-0155
Provider Business Practice Location Address Fax Number:
321-751-0079
Provider Enumeration Date:
05/08/2007

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:  MH7231 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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