1891728242 NPI number — MRS. ELIZABETH (BETSY) M MCCONNELL MSW,LICSW,BCD

Table of content: MRS. ELIZABETH (BETSY) M MCCONNELL MSW,LICSW,BCD (NPI 1891728242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891728242 NPI number — MRS. ELIZABETH (BETSY) M MCCONNELL MSW,LICSW,BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCONNELL
Provider First Name:
ELIZABETH (BETSY)
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW,LICSW,BCD
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:
1891728242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 BAUM BLVD
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206-3793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-871-3438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 BAUM BLVD
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-362-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2006

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:  000113075 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW017609 , 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: 000113075 . This is a "LICENSE NUMBER LICSW" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CW017609 . This is a "PA LICENSE IN CLINICAL SOCIAL SOCIAL WORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PO8562 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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