1699823195 NPI number — CATHERINE ELISE TARNOWSKI LICSW

Table of content: CATHERINE ELISE TARNOWSKI LICSW (NPI 1699823195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699823195 NPI number — CATHERINE ELISE TARNOWSKI LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARNOWSKI
Provider First Name:
CATHERINE
Provider Middle Name:
ELISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMANUS
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699823195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 BALD HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWFIELDS
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03856-8100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-852-5355
Provider Business Mailing Address Fax Number:
603-499-4801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 BALD HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWFIELDS
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03856-8100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-852-5355
Provider Business Practice Location Address Fax Number:
603-499-4801
Provider Enumeration Date:
01/08/2007

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: 1041C0700X , with the licence number:  1032238 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1997 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P08128 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1106340 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1852655 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3107475 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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