1902873508 NPI number — MRS. CATHERINE WINGFIELD MOLZ LCSWC

Table of content: MRS. CATHERINE WINGFIELD MOLZ LCSWC (NPI 1902873508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902873508 NPI number — MRS. CATHERINE WINGFIELD MOLZ LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLZ
Provider First Name:
CATHERINE
Provider Middle Name:
WINGFIELD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
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:
1902873508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 HIGH ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-1307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-778-0234
Provider Business Mailing Address Fax Number:
410-778-2665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 HIGH STREET
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-778-0234
Provider Business Practice Location Address Fax Number:
410-778-2665
Provider Enumeration Date:
03/02/2006

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: 104100000X , with the licence number:  08547 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201946 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5600693 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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