1457459216 NPI number — KATHLEEN STEPHANIE VAN FOSSEN LCSWC

Table of content: KATHLEEN STEPHANIE VAN FOSSEN LCSWC (NPI 1457459216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457459216 NPI number — KATHLEEN STEPHANIE VAN FOSSEN LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN FOSSEN
Provider First Name:
KATHLEEN
Provider Middle Name:
STEPHANIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
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:
1457459216
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:
300 TALBOT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-822-1018
Provider Business Mailing Address Fax Number:
410-820-5884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 DEL RHODES
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
QUEENSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-827-6300
Provider Business Practice Location Address Fax Number:
410-827-6363
Provider Enumeration Date:
09/20/2006

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com