1013041995 NPI number — MRS. CYNTHIA J. BEHM MSW

Table of content: MELISSA M SHAW P.T. (NPI 1164501565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013041995 NPI number — MRS. CYNTHIA J. BEHM MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHM
Provider First Name:
CYNTHIA
Provider Middle Name:
J.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1013041995
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:
8845 OLD STAGECOACH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-4933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-932-0323
Provider Business Mailing Address Fax Number:
301-753-4991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 EAST CHARLES STREET
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-753-8306
Provider Business Practice Location Address Fax Number:
301-753-4991
Provider Enumeration Date:
03/15/2007

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: 1041C0700X , with the licence number:  10796 , 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)

  • Identifier: K103 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 212554 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 331053 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 732251-0000 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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