1477528719 NPI number — DR. CAROL LEE STEINBERG PHD

Table of content: (NPI 1962649186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477528719 NPI number — DR. CAROL LEE STEINBERG PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEINBERG
Provider First Name:
CAROL
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1477528719
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:
327 D BOSTON POST RD
Provider Second Line Business Mailing Address:
WAYSIDE COUNSELING ASSOCIATES
Provider Business Mailing Address City Name:
SUDBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-443-4262
Provider Business Mailing Address Fax Number:
978-443-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 D BOSTON POST RD
Provider Second Line Business Practice Location Address:
WAYSIDE COUNSELING ASSOCIATES
Provider Business Practice Location Address City Name:
SUDBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-443-4262
Provider Business Practice Location Address Fax Number:
978-443-4262
Provider Enumeration Date:
02/21/2006

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: 103TB0200X , with the licence number:  1904 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 207282 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5007036 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61848 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 713300 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W02071 . This is a "BLUE SHIELD OF MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A001770 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0513466 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207282 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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