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1053476473 NPI number — JOAN TIBALDI LCSW, BCD

NPI Number: 1053476473
Health Care Provider/Practitioner: JOAN TIBALDI LCSW, BCD

Information about “1053476473” NPI (JOAN TIBALDI LCSW, BCD) exists in 1053476473 in HTML format HTML  |  1053476473 in plain Text format TXT  |  1053476473 in PDF (Portable Document Format) PDF  |  1053476473 in an XML format XML  formats.

NPI Number : 1053476473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053476473",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TIBALDI",
    "FirstName": "JOAN",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW, BCD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "612 COPPERHEAD CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT AUGUSTINE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32092-2733",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-679-4321",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "612 COPPERHEAD CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT AUGUSTINE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32092-2733",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-679-4321",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/26/2006",
    "LastUpdateDate": "10/11/2019",
    "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": "R20522",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW15600",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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