1558421909 NPI number — MRS. PATRICIA J BALDUCCI LCSWC

Table of content: MRS. PATRICIA J BALDUCCI LCSWC (NPI 1558421909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558421909 NPI number — MRS. PATRICIA J BALDUCCI LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDUCCI
Provider First Name:
PATRICIA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
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:
1558421909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONOWINGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21918-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-378-9696
Provider Business Mailing Address Fax Number:
410-378-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29787 JOHN J WILLIAMS HWY UNIT 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966-4097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-818-8680
Provider Business Practice Location Address Fax Number:
800-818-8680
Provider Enumeration Date:
12/08/2006

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:  03640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: Q1-0001330 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KC83K1 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100026715001 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T460 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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