1972668044 NPI number — MS. MADELEINE PLUHAR MSW, LICSW

Table of content: MS. MADELEINE PLUHAR MSW, LICSW (NPI 1972668044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972668044 NPI number — MS. MADELEINE PLUHAR MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUHAR
Provider First Name:
MADELEINE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
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:
1972668044
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:
BROADWAY ROAD ROUTE 113
Provider Second Line Business Mailing Address:
CADM, DRACUT VILLAGE SQUARE
Provider Business Mailing Address City Name:
DRACUT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-934-9444
Provider Business Mailing Address Fax Number:
978-441-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BROADWAY ROAD ROUTE 113
Provider Second Line Business Practice Location Address:
CADM, DRACUT VILLAGE SQUARE
Provider Business Practice Location Address City Name:
DRACUT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-934-9444
Provider Business Practice Location Address Fax Number:
978-441-0800
Provider Enumeration Date:
12/27/2006

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:  110431 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1894595 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P08072 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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