1730239443 NPI number — MRS. MARY CREEL WEBB LCSWR

Table of content: MRS. MARY CREEL WEBB LCSWR (NPI 1730239443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730239443 NPI number — MRS. MARY CREEL WEBB LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
MARY
Provider Middle Name:
CREEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
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:
1730239443
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:
1001 ELEVENTH STREET
Provider Second Line Business Mailing Address:
TROTT ACCESS CENTER
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-278-1940
Provider Business Mailing Address Fax Number:
716-278-1943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 ELEVENTH STREET
Provider Second Line Business Practice Location Address:
TROTT ACCESS CENTER
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-278-1940
Provider Business Practice Location Address Fax Number:
716-278-1943
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: 104100000X , with the licence number:  R0493451 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000526538002 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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