1497709935 NPI number — MS. KAREN GOLDMAN MARULLO LPC

Table of content: MS. KAREN GOLDMAN MARULLO LPC (NPI 1497709935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497709935 NPI number — MS. KAREN GOLDMAN MARULLO LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARULLO
Provider First Name:
KAREN
Provider Middle Name:
GOLDMAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSHAN
Provider Other First Name:
KAREN
Provider Other Middle Name:
GOLDMAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497709935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 SOUTH 52ND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-530-6855
Provider Business Mailing Address Fax Number:
205-510-2790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2909 CRESCENT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-530-6855
Provider Business Practice Location Address Fax Number:
205-510-2790
Provider Enumeration Date:
05/20/2006

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: 101YP2500X , with the licence number:  1000 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6227769 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51516251 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 330000034 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51521563 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 6284664 . This is a "ALL KIDS INSURANCE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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