NPI Code Detail JSON Logo

1053507020 NPI number — TRACEY NICOLE WAITE LCSW

NPI Number: 1053507020
Health Care Provider/Practitioner: TRACEY NICOLE WAITE LCSW

Information about “1053507020” NPI (TRACEY NICOLE WAITE LCSW) exists in 1053507020 in HTML format HTML  |  1053507020 in plain Text format TXT  |  1053507020 in PDF (Portable Document Format) PDF  |  1053507020 in an XML format XML  formats.

NPI Number : 1053507020 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053507020",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAITE",
    "FirstName": "TRACEY",
    "MiddleName": "NICOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WAITE",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1355 S INTERNATIONAL PKWY",
    "SecondLineMailingAddress": "STE 1481",
    "MailingAddressCityName": "LAKE MARY",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32746-1694",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-559-7011",
    "MailingAddressFaxNumber": "407-559-5443",
    "FirstLinePracticeLocationAddress": "725 N 12TH AVE BLDG B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARCADIA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34266-8752",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "863-494-1242",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2007",
    "LastUpdateDate": "01/10/2022",
    "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": "SW 8162",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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