1932329455 NPI number — CAROL LUCILLE IRELAND LCSW C MSW

Table of content: CAROL LUCILLE IRELAND LCSW C MSW (NPI 1932329455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932329455 NPI number — CAROL LUCILLE IRELAND LCSW C MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRELAND
Provider First Name:
CAROL
Provider Middle Name:
LUCILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW C MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IRELAND
Provider Other First Name:
CAROL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932329455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MILFORD STREET
Provider Second Line Business Mailing Address:
SUITE 501-B
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-336-3027
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MILFORD STREET
Provider Second Line Business Practice Location Address:
SUITE 501-B
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-3121
Provider Business Practice Location Address Fax Number:
410-641-4496
Provider Enumeration Date:
04/26/2007

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:  07870 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 07870 , 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)





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