1053686923 NPI number — BELLISA REICHELT MSW, LMSW, QMHP-A

NPI Number: 1053686923
Health Care Provider/Practitioner: BELLISA REICHELT MSW, LMSW, QMHP-A

NPI Number : 1053686923 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053686923",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REICHELT",
    "FirstName": "BELLISA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LMSW, QMHP-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3900 FAIRFAX DR UNIT 1613",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARLINGTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22203-1690",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-814-6117",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3900 FAIRFAX DR UNIT 1613",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARLINGTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22203-1690",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-814-6117",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/12/2012",
    "LastUpdateDate": "08/19/2019",
    "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": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}