1710991310 NPI number — MS. TERESA A PADULA LCSWE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710991310 NPI number — MS. TERESA A PADULA LCSWE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADULA
Provider First Name:
TERESA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWE
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:
1710991310
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:
120 SISTER PIERRE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-6408
Provider Business Practice Location Address Fax Number:
443-279-0537
Provider Enumeration Date:
07/28/2006

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: 1041C0700X , with the licence number:  02304 , 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: 2151931 . This is a "CIGN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 276549 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4116087 . This is a "MAMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253551 . This is a "COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53564205 . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150N12BG . This is a "MBMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0015 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 226288 . This is a "KAIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PVPB119592 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100475 . This is a "VAL" identifier . This identifiers is of the category "OTHER".




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