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1093220865 NPI number — SARAH ELIZABETH ARDEN DAVIS LCSW

NPI Number: 1093220865
Health Care Provider/Practitioner: SARAH ELIZABETH ARDEN DAVIS LCSW

Information about “1093220865” NPI (SARAH ELIZABETH ARDEN DAVIS LCSW) exists in 1093220865 in HTML format HTML  |  1093220865 in plain Text format TXT  |  1093220865 in PDF (Portable Document Format) PDF  |  1093220865 in an XML format XML  formats.

NPI Number : 1093220865 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093220865",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "SARAH",
    "MiddleName": "ELIZABETH ARDEN",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2357 HASSELL RD STE 202",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOFFMAN ESTATES",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60169-2172",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-863-2620",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2357 HASSELL RD STE 202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOFFMAN ESTATES",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60169-2172",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-466-7775",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/02/2017",
    "LastUpdateDate": "12/02/2017",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "149.019876",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TP2701X",
          "TaxonomyName": "Group Psychotherapy Psychologist",
          "LicenseNumber": "149.019876",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0855X",
          "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
          "LicenseNumber": "149.019876",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "149.019876",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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