1659572436 NPI number — MRS. JEAN CATHERINE MACCONCHIE LPC

Table of content: MRS. JEAN CATHERINE MACCONCHIE LPC (NPI 1659572436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659572436 NPI number — MRS. JEAN CATHERINE MACCONCHIE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACCONCHIE
Provider First Name:
JEAN
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1659572436
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:
470 PROSPECT AVE STE 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-731-6970
Provider Business Mailing Address Fax Number:
973-731-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 SYLVAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTHERFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07070-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-896-0792
Provider Business Practice Location Address Fax Number:
201-804-8765
Provider Enumeration Date:
05/30/2007

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: 101YP2500X , with the licence number:  37PC00223400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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