1740666403 NPI number — LINDSAY PENNY PRIZER LCSW

Table of content: LINDSAY PENNY PRIZER LCSW (NPI 1740666403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740666403 NPI number — LINDSAY PENNY PRIZER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIZER
Provider First Name:
LINDSAY
Provider Middle Name:
PENNY
Provider Name Prefix Text:
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:
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:
1740666403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 CLIFTON RD
Provider Second Line Business Mailing Address:
SUITE 1046 PALLIATIVE CARE CENTER AT WESLEY WOODS,
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-430-6091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 CLIFTON RD NE
Provider Second Line Business Practice Location Address:
SUITE 1046
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30329-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-430-6091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2015

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:  CSW004948 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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