1548477847 NPI number — KARYN RUTH PRICE LMSW

Table of content: KARYN RUTH PRICE LMSW (NPI 1548477847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548477847 NPI number — KARYN RUTH PRICE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
KARYN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1548477847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14461 ROOSEVELT AVE
Provider Second Line Business Mailing Address:
THE SHIELD INSTITUTE
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-6252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-229-5757
Provider Business Mailing Address Fax Number:
718-939-0881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39-09 214TH PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-229-5757
Provider Business Practice Location Address Fax Number:
718-939-0881
Provider Enumeration Date:
05/17/2007

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: 104100000X , with the licence number:  051121-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 079654 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03512558 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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