Basic Information
| Provider Information | |||||||||
| NPI: | 1669484325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIROOZ | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 235 CANTRELL AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645960 | ||||||||
| FaxNumber: | 5404334338 | ||||||||
| Practice Location | |||||||||
| Address1: | 752 OTT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645960 | ||||||||
| FaxNumber: | 5404334338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701001289 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 010142440 | 05 | VA | MEDICAID | 000662 | 01 | VA | VALUE OPTIONS | OTHER | 175521 | 01 | VA | ANTHEM PROVIDER NUMBER | OTHER | 1164637518 | 01 | VA | GROUP NPI NUMBER | OTHER | 2222600 | 01 | VA | CIGNA PROVIDER NUMBER | OTHER | 085544M | 01 | VA | SENTARA PROVIDER NUMBER | OTHER | 11527091 | 01 | VA | CAQH PROVIDER NUMBER | OTHER | 244585 | 01 | VA | COMPSYCH PROVIDER NUMBER | OTHER | C05754 | 01 | VA | MEDICARE GROUP NUMBER | OTHER |