1457403362 NPI number — MS. ELIZABETH BAYLEY MCMAHON OKEEFE LICSW

Table of content: MS. ELIZABETH BAYLEY MCMAHON OKEEFE LICSW (NPI 1457403362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457403362 NPI number — MS. ELIZABETH BAYLEY MCMAHON OKEEFE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKEEFE
Provider First Name:
ELIZABETH
Provider Middle Name:
BAYLEY MCMAHON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKEEFE
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457403362
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:
5 ADAMS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALPOLE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-313-4011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 ADAMS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALPOLE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-313-4011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2007

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: 1041C0700X , with the licence number:  348 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30424055 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74479 . This is a "PBH UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11553094 . This is a "CAQH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 042781 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1053490 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 14YM9979NH01 . This is a "BCBS ANTHEM BHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 6296196 . This is a "UBH PACIFIC HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7839503 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".