1588750053 NPI number — ROBERTA MANESS ALLEN MSW

Table of content: ROBERTA MANESS ALLEN MSW (NPI 1588750053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588750053 NPI number — ROBERTA MANESS ALLEN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
ROBERTA
Provider Middle Name:
MANESS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1588750053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 728
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARNOLD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21012-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-544-2287
Provider Business Mailing Address Fax Number:
410-544-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 GLEN OBAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARNOLD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21012-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-544-2287
Provider Business Practice Location Address Fax Number:
410-544-4663
Provider Enumeration Date:
10/04/2006

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:  02558 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410194-02 . This is a "BC/BS RENDERING PROVIDER#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: QD31RM . This is a "PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R9200001 . This is a "FEDERAL BC/BS PROVIDER#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 283036000 . This is a "MAGELLAN PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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