1467661769 NPI number — MRS. MARCY R. VAYDER M.S.W., L.C.S.W.

Table of content: MRS. MARCY R. VAYDER M.S.W., L.C.S.W. (NPI 1467661769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467661769 NPI number — MRS. MARCY R. VAYDER M.S.W., L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAYDER
Provider First Name:
MARCY
Provider Middle Name:
R.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIXSON
Provider Other First Name:
MARCY
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
S.W.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467661769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95617-0622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-756-7542
Provider Business Mailing Address Fax Number:
916-875-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1784 PICASSO AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95618-0551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-756-7542
Provider Business Practice Location Address Fax Number:
530-756-2931
Provider Enumeration Date:
05/22/2007

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:  23058 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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