1043736416 NPI number — KRISTIN ELIZABETH POLLOCK MA, BC-DMT, LPC, ACS

NPI Number: 1043736416
Health Care Provider/Practitioner: KRISTIN ELIZABETH POLLOCK MA, BC-DMT, LPC, ACS

NPI Number : 1043736416 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043736416",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POLLOCK",
    "FirstName": "KRISTIN",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, BC-DMT, LPC, ACS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "416 NEWTON AVE.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKLYN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-313-3160",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "509 N BROAD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBURY",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08096-1617",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-686-5634",
    "PracticeLocationAddressFaxNumber": "856-686-5119",
    "EnumerationDate": "08/17/2017",
    "LastUpdateDate": "08/17/2017",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "37PC00388400",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}