1619267010 NPI number — MS. JULEEN ANN CHIARADONNA MSW, LICSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619267010 NPI number — MS. JULEEN ANN CHIARADONNA MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIARADONNA
Provider First Name:
JULEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
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:
1619267010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 MARKET PLACE DR
Provider Second Line Business Mailing Address:
SUITE 202A
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-387-4388
Provider Business Mailing Address Fax Number:
603-522-8768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 MARKET PLACE DR
Provider Second Line Business Practice Location Address:
SUITE 202A
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-387-4388
Provider Business Practice Location Address Fax Number:
603-522-8768
Provider Enumeration Date:
04/19/2011

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:  LC13360 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 1440 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1619267010 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003014301 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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