1487774378 NPI number — MS. DEBRA W HANRATTY LCSW,BSW,MSW

Table of content: MS. DEBRA W HANRATTY LCSW,BSW,MSW (NPI 1487774378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487774378 NPI number — MS. DEBRA W HANRATTY LCSW,BSW,MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANRATTY
Provider First Name:
DEBRA
Provider Middle Name:
W
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW,BSW,MSW
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:
1487774378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AWAKEN THE POWER THERAPY, LLC 58 RIVER STREET
Provider Second Line Business Mailing Address:
SUITE#10
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-7044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-693-1050
Provider Business Mailing Address Fax Number:
203-306-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
883 PADDOCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06450-7044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-630-5305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

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:  5152 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14026266 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 472092928 . This is a "ANTHEM BCBS OF CT BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038010 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 472092928 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2651131 . This is a "VALUE OPTIONS/RUSHFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2651131 . This is a "UNITED BEHAVIORAL HEALTH-OPTUM/RUSHFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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