1851758593 NPI number — KRISTEN M ZEROVNIK LPC

Table of content: KRISTEN M ZEROVNIK LPC (NPI 1851758593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851758593 NPI number — KRISTEN M ZEROVNIK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEROVNIK
Provider First Name:
KRISTEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAMES
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
MARIE
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:
1851758593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 E HIGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17022-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-489-2901
Provider Business Mailing Address Fax Number:
717-366-4662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 BRUCE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT JOY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-489-2901
Provider Business Practice Location Address Fax Number:
717-366-4662
Provider Enumeration Date:
01/26/2016

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: 101YM0800X , with the licence number:  LH60779557 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PC011488 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104123191-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085716 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PC011488 . This is a "LPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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