NPI Code Detail JSON Logo

1003253105 NPI number — KELLY DAWNE MCBRIDE LCSW

NPI Number: 1003253105
Health Care Provider/Practitioner: KELLY DAWNE MCBRIDE LCSW

Information about “1003253105” NPI (KELLY DAWNE MCBRIDE LCSW) exists in 1003253105 in HTML format HTML  |  1003253105 in plain Text format TXT  |  1003253105 in PDF (Portable Document Format) PDF  |  1003253105 in an XML format XML  formats.

NPI Number : 1003253105 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003253105",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCBRIDE",
    "FirstName": "KELLY",
    "MiddleName": "DAWNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "926 GATES ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST PALO ALTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94303-2550",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-739-5951",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "650 CLARK WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALO ALTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94304-2300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "650-617-3834",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/29/2013",
    "LastUpdateDate": "04/07/2015",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "ASW 35261",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041S0200X",
          "TaxonomyName": "School Social Worker",
          "LicenseNumber": "LCSW65066",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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