1902875008 NPI number — MS. VICTORIA ANN HARWOOD LCSW, CAP

Table of content: MS. VICTORIA ANN HARWOOD LCSW, CAP (NPI 1902875008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902875008 NPI number — MS. VICTORIA ANN HARWOOD LCSW, CAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARWOOD
Provider First Name:
VICTORIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CAP
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:
1902875008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438 MYRTLEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-7734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-409-9191
Provider Business Mailing Address Fax Number:
321-409-9191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S HARBOR CITY BLVD
Provider Second Line Business Practice Location Address:
STE 216
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-409-9191
Provider Business Practice Location Address Fax Number:
321-409-9191
Provider Enumeration Date:
03/14/2006

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:  SW0002856 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: U04762015 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 070354 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 255651000 . This is a "MBHC MIS#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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