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1053345504 NPI number — JEANNETTE STICCO BERTUCELLI R-LCSW:ACSW

NPI Number: 1053345504
Health Care Provider/Practitioner: JEANNETTE STICCO BERTUCELLI R-LCSW:ACSW

Information about “1053345504” NPI (JEANNETTE STICCO BERTUCELLI R-LCSW:ACSW) exists in 1053345504 in HTML format HTML  |  1053345504 in plain Text format TXT  |  1053345504 in PDF (Portable Document Format) PDF  |  1053345504 in an XML format XML  formats.

NPI Number : 1053345504 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053345504",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERTUCELLI",
    "FirstName": "JEANNETTE",
    "MiddleName": "STICCO",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "R-LCSW:ACSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PROFESSIONAL PLAZA 233 7TH ST.",
    "SecondLineMailingAddress": "2FL SUITE",
    "MailingAddressCityName": "GARDEN CITY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11530-4147",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-662-8258",
    "MailingAddressFaxNumber": "516-385-2913",
    "FirstLinePracticeLocationAddress": "PROFESSIONAL PLAZA 233 7TH ST.",
    "SecondLinePracticeLocationAddress": "2FL SUITE",
    "PracticeLocationAddressCityName": "GARDEN CITY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11530-4147",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-662-8258",
    "PracticeLocationAddressFaxNumber": "516-385-2913",
    "EnumerationDate": "07/10/2006",
    "LastUpdateDate": "11/12/2009",
    "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": "069435",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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