1477162121 NPI number — LUCIA BELLINGER DAVIS CASAC2

Table of content: LUCIA BELLINGER DAVIS CASAC2 (NPI 1477162121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477162121 NPI number — LUCIA BELLINGER DAVIS CASAC2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
LUCIA
Provider Middle Name:
BELLINGER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASAC2
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:
1477162121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PALTZ
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12561-0211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-359-0095
Provider Business Mailing Address Fax Number:
518-514-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 SCOFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12586-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-778-5628
Provider Business Practice Location Address Fax Number:
845-778-5168
Provider Enumeration Date:
07/29/2020

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24487 . This is a "NYS OASAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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