1811550437 NPI number — KATHARINE ELISE HAZARD NEUBURGER LMSW

Table of content: KATHARINE ELISE HAZARD NEUBURGER LMSW (NPI 1811550437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811550437 NPI number — KATHARINE ELISE HAZARD NEUBURGER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUBURGER
Provider First Name:
KATHARINE
Provider Middle Name:
ELISE HAZARD
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:
VALLERAND
Provider Other First Name:
KATHARINE
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:
1811550437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1723 RUSTIC RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48188-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-390-9768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23965 NOVI RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48375-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-344-7420
Provider Business Practice Location Address Fax Number:
248-344-7423
Provider Enumeration Date:
04/18/2019

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:  6801103868 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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