1902850589 NPI number — LONGVIEW PSYCHOTHERAPY PC

Table of content: (NPI 1902850589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902850589 NPI number — LONGVIEW PSYCHOTHERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONGVIEW PSYCHOTHERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902850589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-541-9364
Provider Business Mailing Address Fax Number:
888-765-8406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04103-3636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-541-9364
Provider Business Practice Location Address Fax Number:
888-765-8406
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CURRAN
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-541-9364

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC3829 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100012 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2110108 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 5489-01 . This is a "PACIFICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".