1548770431 NPI number — TRICIA FRANCES DENNIS LMHC

Table of content: TRICIA FRANCES DENNIS LMHC (NPI 1548770431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548770431 NPI number — TRICIA FRANCES DENNIS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNIS
Provider First Name:
TRICIA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EXNER-DENNIS
Provider Other First Name:
TRICIA
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548770431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 GRANT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13021-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 GENESEE ST STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13021-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-253-8477
Provider Business Practice Location Address Fax Number:
315-253-4727
Provider Enumeration Date:
10/04/2017

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: 101YM0800X , with the licence number:  008190 , 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: 008190-1 . This is a "MENTAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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