1871929182 NPI number — MRS. VICTORIA EUGENIA ECHEVERRY

Table of content: MRS. VICTORIA EUGENIA ECHEVERRY (NPI 1871929182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871929182 NPI number — MRS. VICTORIA EUGENIA ECHEVERRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECHEVERRY
Provider First Name:
VICTORIA
Provider Middle Name:
EUGENIA
Provider Name Prefix Text:
MRS.
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:
ECHEVERRY
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
EUGENIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871929182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 WEKIVA SPRINGS RD
Provider Second Line Business Mailing Address:
SUITE104
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32779-6201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-222-4207
Provider Business Mailing Address Fax Number:
386-860-0649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 WEKIVA SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-222-4207
Provider Business Practice Location Address Fax Number:
386-860-0649
Provider Enumeration Date:
09/18/2013

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020716400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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