1558423111 NPI number — KAREN L CRATZ LCSW

Table of content: KAREN L CRATZ LCSW (NPI 1558423111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558423111 NPI number — KAREN L CRATZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRATZ
Provider First Name:
KAREN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1558423111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 30170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19805-7170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-623-7109
Provider Business Mailing Address Fax Number:
302-623-7374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 NORTH WASHINGTON ST.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-477-3300
Provider Business Practice Location Address Fax Number:
302-477-3168
Provider Enumeration Date:
12/13/2006

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:  Q1-0000579 , 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: 003289C29 . This is a "MEDICARE PIN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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