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1104367119 NPI number — TATIANA TOMOVIC LCSW

NPI Number: 1104367119
Health Care Provider/Practitioner: TATIANA TOMOVIC LCSW

Information about “1104367119” NPI (TATIANA TOMOVIC LCSW) exists in 1104367119 in HTML format HTML  |  1104367119 in plain Text format TXT  |  1104367119 in PDF (Portable Document Format) PDF  |  1104367119 in an XML format XML  formats.

NPI Number : 1104367119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104367119",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TOMOVIC",
    "FirstName": "TATIANA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AL HAMEED",
    "OtherFirstName": "TATIANA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1080",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURKESVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "42717-1080",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "270-864-1472",
    "MailingAddressFaxNumber": "270-864-1693",
    "FirstLinePracticeLocationAddress": "6350 OLD SCOTTSVILLE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALVATON",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42122-9767",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "844-435-0900",
    "PracticeLocationAddressFaxNumber": "270-858-4029",
    "EnumerationDate": "03/10/2017",
    "LastUpdateDate": "09/09/2025",
    "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": "254803",
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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