1619268653 NPI number — PARADIGM THERAPY PARTNERS LLC

Table of content: (NPI 1619268653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619268653 NPI number — PARADIGM THERAPY PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADIGM THERAPY PARTNERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1619268653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6368 COVENTRY WAY
Provider Second Line Business Mailing Address:
363
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-264-1621
Provider Business Mailing Address Fax Number:
888-242-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4483 FORBES BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-4377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-479-6769
Provider Business Practice Location Address Fax Number:
888-242-8040
Provider Enumeration Date:
04/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
ERIKA
Authorized Official Middle Name:
MINES
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
240-264-1621

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  05814 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT010000263 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1619268653 . This is a "NPPES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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