1790821296 NPI number — MS. DONA LEA WHEELER LICSW

Table of content: MS. DONA LEA WHEELER LICSW (NPI 1790821296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790821296 NPI number — MS. DONA LEA WHEELER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
DONA
Provider Middle Name:
LEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARDEE
Provider Other First Name:
DONA
Provider Other Middle Name:
WHEELER
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:
1790821296
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:
PO BOX 534
Provider Second Line Business Mailing Address:
55 PUTNEY RD
Provider Business Mailing Address City Name:
LEVERETT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01054-9534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-549-0051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
NORTHHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-348-6257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

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: 104100000X , with the licence number:  104283 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1853627 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com