1750011680 NPI number — AUBREY LEIGH SPADIN LMSW

Table of content: AUBREY LEIGH SPADIN LMSW (NPI 1750011680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750011680 NPI number — AUBREY LEIGH SPADIN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPADIN
Provider First Name:
AUBREY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRUCCIO
Provider Other First Name:
AUBREY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750011680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 PARKER RD APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-9038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-736-6644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23704 OCEAN GTWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARDELA SPRINGS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21837-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-742-7400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2022

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: 104100000X , with the licence number:  28709 , 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: 160008700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com