1790987329 NPI number — NORMA LETICIA DELAROSA M.A., CCC-A

Table of content: NORMA LETICIA DELAROSA M.A., CCC-A (NPI 1790987329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790987329 NPI number — NORMA LETICIA DELAROSA M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELAROSA
Provider First Name:
NORMA
Provider Middle Name:
LETICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
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:
1790987329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 N LEBANON ST STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46052-8622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2485 E WABASH ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46041-9400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-659-7400
Provider Business Practice Location Address Fax Number:
765-659-7408
Provider Enumeration Date:
06/05/2007

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: 231H00000X , with the licence number:  23001990A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300023109 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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