1881965440 NPI number — MS. TRACEY DINEEN-HUTCHINS LPC, LADC

Table of content: MS. TRACEY DINEEN-HUTCHINS LPC, LADC (NPI 1881965440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881965440 NPI number — MS. TRACEY DINEEN-HUTCHINS LPC, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINEEN-HUTCHINS
Provider First Name:
TRACEY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LADC
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:
1881965440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 EKONK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOLUNTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06384-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 PENNSLYVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
NIANTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06357-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-861-7047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2012

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: 101YA0400X , with the licence number:  000713 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 000714 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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