1528102175 NPI number — MS. CAROL SIMPSON DAWIDOWICZ MFT

Table of content: MS. CAROL SIMPSON DAWIDOWICZ MFT (NPI 1528102175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528102175 NPI number — MS. CAROL SIMPSON DAWIDOWICZ MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWIDOWICZ
Provider First Name:
CAROL
Provider Middle Name:
SIMPSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMPSON
Provider Other First Name:
CAROL
Provider Other Middle Name:
KIRKLAND
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528102175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3761 VILLA TER APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92104-3491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-568-0456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5480 BALTIMORE DR
Provider Second Line Business Practice Location Address:
SUITE #250
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-568-0456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2007

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: 106H00000X , with the licence number:  49433 , 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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