1710017843 NPI number — MRS. VIJAYA K MURTY-VELAMAKANNI LCSW

Table of content: MRS. VIJAYA K MURTY-VELAMAKANNI LCSW (NPI 1710017843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710017843 NPI number — MRS. VIJAYA K MURTY-VELAMAKANNI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURTY-VELAMAKANNI
Provider First Name:
VIJAYA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURTY
Provider Other First Name:
VIJAYA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710017843
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:
22655 BAYSHORE RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33980-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-766-8835
Provider Business Mailing Address Fax Number:
941-629-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22655 BAYSHORE RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-766-8835
Provider Business Practice Location Address Fax Number:
941-629-1111
Provider Enumeration Date:
03/07/2007

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:  SW5984 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com