1588833875 NPI number — JENNIFER MAY CATALETA LCSW

Table of content: KIRA J BURLESON (NPI 1790215481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588833875 NPI number — JENNIFER MAY CATALETA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATALETA
Provider First Name:
JENNIFER
Provider Middle Name:
MAY
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:
1588833875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1880 E MORTEN AVE APT 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
329-454-2299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 26610
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09036
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
499318897768
Provider Business Practice Location Address Fax Number:
499318897772
Provider Enumeration Date:
02/21/2008

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: 101YA0400X , with the licence number:  LISAC 10639 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW 2785 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LISAC 10639 . This is a "LISAC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: LCSW2785 . This is a "LCSW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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