1588750053 NPI number — ROBERTA MANESS ALLEN MSW

Table of content: TERRA BARTON (NPI 1831951482)

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".




Copyright © 2007-2025 www.npivalidator.com