1992941116 NPI number — MRS. PAMELA JO LUBIN MCGUIRE LCSW

Table of content: MRS. PAMELA JO LUBIN MCGUIRE LCSW (NPI 1992941116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992941116 NPI number — MRS. PAMELA JO LUBIN MCGUIRE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUIRE
Provider First Name:
PAMELA
Provider Middle Name:
JO LUBIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1992941116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06107-3452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-983-1679
Provider Business Mailing Address Fax Number:
860-516-1537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-983-1679
Provider Business Practice Location Address Fax Number:
860-516-1537
Provider Enumeration Date:
12/17/2008

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:  006917 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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