1518017250 NPI number — VICTORIA PARKER LEISURE M.S., L.P.C., C.A.C.

Table of content: VICTORIA PARKER LEISURE M.S., L.P.C., C.A.C. (NPI 1518017250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518017250 NPI number — VICTORIA PARKER LEISURE M.S., L.P.C., C.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEISURE
Provider First Name:
VICTORIA
Provider Middle Name:
PARKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.P.C., C.A.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
VICKIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., L.P.C., C.A.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518017250
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:
668 LAUREL VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHEIM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17545-9791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-372-8181
Provider Business Mailing Address Fax Number:
717-664-2846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2461 LITITZ PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-475-0882
Provider Business Practice Location Address Fax Number:
717-560-3995
Provider Enumeration Date:
01/12/2007

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: 101YA0400X , with the licence number:  CAC0898 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: PC001680 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 50046062 . This is a "CAPITAL BLUE CROSS ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 520817 . This is a "VALUEOPTIONS ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11615745 . This is a "CAQH NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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