1790827301 NPI number — PATRICIA BLAES

Table of content: PATRICIA BLAES (NPI 1790827301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790827301 NPI number — PATRICIA BLAES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAES
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHATELAIN
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790827301
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:
4602 ROSEDALE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-3716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-907-0707
Provider Business Mailing Address Fax Number:
301-309-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-309-8200
Provider Business Practice Location Address Fax Number:
301-309-9667
Provider Enumeration Date:
02/12/2007

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: 1041C0700X , with the licence number:  05471 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LC301796 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2236 0001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com