1588770523 NPI number — MRS. MIRIAM M LOVE L.C.S.W-C

Table of content: MRS. MIRIAM M LOVE L.C.S.W-C (NPI 1588770523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588770523 NPI number — MRS. MIRIAM M LOVE L.C.S.W-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVE
Provider First Name:
MIRIAM
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W-C
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:
1588770523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11041 DORSCH FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21042-6267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-992-1469
Provider Business Mailing Address Fax Number:
441-038-1471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7120 MINSTREL WAY
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-325-1151
Provider Business Practice Location Address Fax Number:
410-381-4711
Provider Enumeration Date:
08/22/2006

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:  10061 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904001503 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PVPB108875 . This is a "APS PROV #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 10061 . This is a "MD PROFESSIONAL LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 465267 . This is a "MAMSI PROV #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 279529 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0904001503 . This is a "PROFESSIONAL LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: S0694 . This is a "CIGNA PROV #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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