1881775278 NPI number — MS. SARAH T GOEBEL MSW, LCSW-R

Table of content: MS. SARAH T GOEBEL MSW, LCSW-R (NPI 1881775278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881775278 NPI number — MS. SARAH T GOEBEL MSW, LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEBEL
Provider First Name:
SARAH
Provider Middle Name:
T
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-R
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:
1881775278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
7 SUNNYSIDE AVE.
Provider Business Mailing Address City Name:
BEMUS POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14712-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-386-5033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ERIE DEPT. OF VETERAN AFFAIRS MEDICAL CENTER
Provider Second Line Business Practice Location Address:
135 EAST 38TH ST.
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-860-2038
Provider Business Practice Location Address Fax Number:
814-860-2110
Provider Enumeration Date:
10/18/2006

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:  R029218-1 , 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)





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