1548368202 NPI number — MRS. JENNIFER HASKINS SHREWSBURY MSW, LCSW

Table of content: MRS. JENNIFER HASKINS SHREWSBURY MSW, LCSW (NPI 1548368202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548368202 NPI number — MRS. JENNIFER HASKINS SHREWSBURY MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHREWSBURY
Provider First Name:
JENNIFER
Provider Middle Name:
HASKINS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASKINS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LINN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548368202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 VEAZEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27509-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-764-2245
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 VEASEY RD
Provider Second Line Business Practice Location Address:
GEROPSYCHIATRY
Provider Business Practice Location Address City Name:
BUTNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-764-5630
Provider Business Practice Location Address Fax Number:
919-764-5868
Provider Enumeration Date:
09/20/2006

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: 1041C0700X , with the licence number:  C002647 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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