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1093977100 NPI number — MARJORIE LIZA BOWN LCSW

NPI Number: 1093977100
Health Care Provider/Practitioner: MARJORIE LIZA BOWN LCSW

Information about “1093977100” NPI (MARJORIE LIZA BOWN LCSW) exists in 1093977100 in HTML format HTML  |  1093977100 in plain Text format TXT  |  1093977100 in PDF (Portable Document Format) PDF  |  1093977100 in an XML format XML  formats.

NPI Number : 1093977100 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093977100",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOWN",
    "FirstName": "MARJORIE",
    "MiddleName": "LIZA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 3064",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MONTCLAIR",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91763-1164",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-896-2433",
    "MailingAddressFaxNumber": "909-284-4111",
    "FirstLinePracticeLocationAddress": "225 W HOSPITALITY LN",
    "SecondLinePracticeLocationAddress": "SUITE 208A",
    "PracticeLocationAddressCityName": "SAN BERNARDINO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92408-3237",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-896-2433",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/30/2008",
    "LastUpdateDate": "01/08/2022",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "29036",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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