1568459550 NPI number — ROBERTA JEAN CUMMINGS LCSW

Table of content: ROBERTA JEAN CUMMINGS LCSW (NPI 1568459550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568459550 NPI number — ROBERTA JEAN CUMMINGS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMMINGS
Provider First Name:
ROBERTA
Provider Middle Name:
JEAN
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:
CUMMINGS
Provider Other First Name:
JEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568459550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 BAYOU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINCENNES
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47591-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-886-6800
Provider Business Mailing Address Fax Number:
812-886-6809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 BUNTIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINCENNES
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47591-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-885-2700
Provider Business Practice Location Address Fax Number:
812-885-2716
Provider Enumeration Date:
10/04/2005

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:  34001211A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000274051 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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