1891702593 NPI number — MS. DOROTHY H DEVINE LCSW

Table of content: MS. DOROTHY H DEVINE LCSW (NPI 1891702593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891702593 NPI number — MS. DOROTHY H DEVINE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVINE
Provider First Name:
DOROTHY
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILL
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
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:
1891702593
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:
1374 PANORAMA RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-631-5908
Provider Business Mailing Address Fax Number:
760-631-5908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 S IVY
Provider Second Line Business Practice Location Address:
CENTER FOR SELF DISCOVERY
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-419-5908
Provider Business Practice Location Address Fax Number:
760-294-2151
Provider Enumeration Date:
08/02/2006

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:  LCS#18485 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 11980 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CSW184850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".