1669131496 NPI number — CASSANDRA ANN HARTLEY PENNINGTON LCSW-A, LCAS-A. MSW

Table of content: CASSANDRA ANN HARTLEY PENNINGTON LCSW-A, LCAS-A. MSW (NPI 1669131496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669131496 NPI number — CASSANDRA ANN HARTLEY PENNINGTON LCSW-A, LCAS-A. MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNINGTON
Provider First Name:
CASSANDRA
Provider Middle Name:
ANN HARTLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-A, LCAS-A. MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTLEY
Provider Other First Name:
CASSANDRA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-A, LCAS-A. MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669131496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAGRAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28396-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 807
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAGRAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28396-0807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-361-5975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2021

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:  LCAS-27531 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: P017735 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5874 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 568946544 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com