1972667574 NPI number — PAULINA ZEL NAISTETER MSW LCSW

Table of content: PAULINA ZEL NAISTETER MSW LCSW (NPI 1972667574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972667574 NPI number — PAULINA ZEL NAISTETER MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAISTETER
Provider First Name:
PAULINA
Provider Middle Name:
ZEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEL
Provider Other First Name:
PAULINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972667574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 LAWLER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-254-2618
Provider Business Mailing Address Fax Number:
215-673-5240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8018 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-254-2618
Provider Business Practice Location Address Fax Number:
215-673-5240
Provider Enumeration Date:
12/20/2006

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:  CW012604 , 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: 2080440 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA01967498 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23005800 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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