1982990701 NPI number — MRS. LAINE MERI BOOKWALTER MSW, LCSW

Table of content: MRS. LAINE MERI BOOKWALTER MSW, LCSW (NPI 1982990701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982990701 NPI number — MRS. LAINE MERI BOOKWALTER MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOKWALTER
Provider First Name:
LAINE
Provider Middle Name:
MERI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCULLON
Provider Other First Name:
LAINE
Provider Other Middle Name:
MERI
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982990701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
787 PITTSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNERDELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16374-4711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-673-1540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20231 PAINT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16254-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-1159
Provider Business Practice Location Address Fax Number:
814-227-2876
Provider Enumeration Date:
06/20/2011

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:  CW024298 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: SW128692 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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