1821104779 NPI number — MR. PAUL A WOLPERT LCSWR

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 1821104779 NPI number — MR. PAUL A WOLPERT LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLPERT
Provider First Name:
PAUL
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
M

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:
1821104779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 MAIN STREET
Provider Second Line Business Mailing Address:
CATHOLIC CHARITIES OF BROOME CO
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-729-9166
Provider Business Mailing Address Fax Number:
607-729-2062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 MAIN STREET
Provider Second Line Business Practice Location Address:
CATHOLIC CHARITIES OF BROOME CO
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13905-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-729-9166
Provider Business Practice Location Address Fax Number:
607-729-2062
Provider Enumeration Date:
08/22/2006

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:  R0434341 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000013577 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 247648 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 618813 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01030SS . This is a "GHI EMPIRE VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426031571 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".




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