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1003108648 NPI number — TAWANA REENA DANIEL ACSW,QCSW,DCSW

NPI Number: 1003108648
Health Care Provider/Practitioner: TAWANA REENA DANIEL ACSW,QCSW,DCSW

Information about “1003108648” NPI (TAWANA REENA DANIEL ACSW,QCSW,DCSW) exists in 1003108648 in HTML format HTML  |  1003108648 in plain Text format TXT  |  1003108648 in PDF (Portable Document Format) PDF  |  1003108648 in an XML format XML  formats.

NPI Number : 1003108648 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003108648",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DANIEL",
    "FirstName": "TAWANA",
    "MiddleName": "REENA",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "ACSW,QCSW,DCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 530336",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LIVONIA",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48153-0336",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-295-4528",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8303 PLATT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALINE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48176-9773",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-295-4528",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/13/2011",
    "LastUpdateDate": "06/21/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health",
          "LicenseNumber": "L1113114",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical",
          "LicenseNumber": "L1113114",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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