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1104254432 NPI number — AUTUMN OWODUNNI

NPI Number: 1104254432
Health Care Provider/Practitioner: AUTUMN OWODUNNI

Information about “1104254432” NPI (AUTUMN OWODUNNI) exists in 1104254432 in HTML format HTML  |  1104254432 in plain Text format TXT  |  1104254432 in PDF (Portable Document Format) PDF  |  1104254432 in an XML format XML  formats.

NPI Number : 1104254432 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104254432",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OWODUNNI",
    "FirstName": "AUTUMN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "110 MAPLE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01105-1864",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "413-732-7419",
    "MailingAddressFaxNumber": "413-781-1059",
    "FirstLinePracticeLocationAddress": "265 SLATER ST APT 416",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06042-8922",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-207-8900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/23/2013",
    "LastUpdateDate": "11/09/2023",
    "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": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6724",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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