1649217993 NPI number — MRS. MICHELLE RENEE PASTERNACK CCSW C

Table of content: MRS. MICHELLE RENEE PASTERNACK CCSW C (NPI 1649217993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649217993 NPI number — MRS. MICHELLE RENEE PASTERNACK CCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASTERNACK
Provider First Name:
MICHELLE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCSW 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:
1649217993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 SISTER PIERRE DRIVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-823-6408
Provider Business Mailing Address Fax Number:
443-279-0537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7130 MINSTREL WAY
Provider Second Line Business Practice Location Address:
SUITE 212
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:
410-290-6940
Provider Business Practice Location Address Fax Number:
410-290-9763
Provider Enumeration Date:
06/02/2006

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: 2084P0800X , with the licence number:  04851 , 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: 150N . This is a "MBMD GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52317109 . This is a "BSMD INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: PVPB119420 . This is a "APS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002668 . This is a "VAL INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253552 . This is a "COMP INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360218 . This is a "MHN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 705BPS . This is a "BSMD GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: K452 . This is a "BSDC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 226570 . This is a "KAIS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150N124G . This is a "MBMD INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 226570 . This is a "KAIS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002668 . This is a "VAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2139989 . This is a "MAMS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0016 . This is a "BSDC INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252450 . This is a "COMP GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331947 . This is a "MHN INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: PVPB119420 . This is a "APS GROUP" identifier . This identifiers is of the category "OTHER".




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