1780763797 NPI number — MARY CATHERINE PROFFITT-ALLISON L.C.S.W.

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 1780763797 NPI number — MARY CATHERINE PROFFITT-ALLISON L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROFFITT-ALLISON
Provider First Name:
MARY
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROFFITT-ALLISON
Provider Other First Name:
CATHY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780763797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E REDLANDS BLVD
Provider Second Line Business Mailing Address:
SUITE 277
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-4775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-3026
Provider Business Mailing Address Fax Number:
909-335-3167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E REDLANDS BLVD
Provider Second Line Business Practice Location Address:
SUITE 277
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92373-4775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-335-3026
Provider Business Practice Location Address Fax Number:
909-335-3167
Provider Enumeration Date:
11/02/2006

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:  21033 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21033 . This is a "L.C.S.W" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com