1992148415 NPI number — MR. CHRISTOPHER ALAN KIDD LICSW, CSW, MSSW

Table of content: MR. CHRISTOPHER ALAN KIDD LICSW, CSW, MSSW (NPI 1992148415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992148415 NPI number — MR. CHRISTOPHER ALAN KIDD LICSW, CSW, MSSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIDD
Provider First Name:
CHRISTOPHER
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW, CSW, MSSW
Provider Gender Code:
M

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:
1992148415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2585 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25703-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-697-1396
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 ADENA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMIT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25674-8063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-393-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2013

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:  6647 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: DP00944383 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q56867A . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1992148415 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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