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1073952164 NPI number — CASSAUNDRA A. COLLINS LCSW

NPI Number: 1073952164
Health Care Provider/Practitioner: CASSAUNDRA A. COLLINS LCSW

Information about “1073952164” NPI (CASSAUNDRA A. COLLINS LCSW) exists in 1073952164 in HTML format HTML  |  1073952164 in plain Text format TXT  |  1073952164 in PDF (Portable Document Format) PDF  |  1073952164 in an XML format XML  formats.

NPI Number : 1073952164 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073952164",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLLINS",
    "FirstName": "CASSAUNDRA",
    "MiddleName": "A.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COLLINS",
    "OtherFirstName": "CASSY",
    "OtherMiddleName": "A.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2504 LAURIE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TWIN FALLS",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83301-0198",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-731-7113",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2647 KIMBERLY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TWIN FALLS",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83301-7976",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-734-1281",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/21/2013",
    "LastUpdateDate": "08/28/2024",
    "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": "LCSW-35305",
        "LicenseNumberStateCode": "ID",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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