1528316221 NPI number — PATRICIA C. NIETSCH MSW

Table of content: PATRICIA C. NIETSCH MSW (NPI 1528316221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528316221 NPI number — PATRICIA C. NIETSCH MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIETSCH
Provider First Name:
PATRICIA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1528316221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 ELIZABETH STREET
Provider Second Line Business Mailing Address:
LOWER NAUGATUCK VALLEY PARENT CHILD RESOURCE CENTER, IN
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-954-0543
Provider Business Mailing Address Fax Number:
203-954-0544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 ELIZABETH STREET
Provider Second Line Business Practice Location Address:
LOWER NAUGATUCK VALLEY PARENT CHILD RESOURCE CENTER, IN
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-954-0543
Provider Business Practice Location Address Fax Number:
203-954-0544
Provider Enumeration Date:
08/28/2012

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

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

  • Identifier: 004039541 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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