1558327353 NPI number — MS. PATIENCE SAMPSON LICSW

Table of content: MS. PATIENCE SAMPSON LICSW (NPI 1558327353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558327353 NPI number — MS. PATIENCE SAMPSON LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMPSON
Provider First Name:
PATIENCE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1558327353
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:
1723 WASHINGTON STREET
Provider Second Line Business Mailing Address:
UNIT 601
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-262-6269
Provider Business Mailing Address Fax Number:
617-536-5665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 BEACON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-262-6269
Provider Business Practice Location Address Fax Number:
617-536-5665
Provider Enumeration Date:
04/21/2006

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: 104100000X , with the licence number:  101757 , 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: P03525 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com