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1104380542 NPI number — BENJAMIN SPEARMAN

NPI Number: 1104380542
Health Care Provider/Practitioner: BENJAMIN SPEARMAN

Information about “1104380542” NPI (BENJAMIN SPEARMAN) exists in 1104380542 in HTML format HTML  |  1104380542 in plain Text format TXT  |  1104380542 in PDF (Portable Document Format) PDF  |  1104380542 in an XML format XML  formats.

NPI Number : 1104380542 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104380542",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPEARMAN",
    "FirstName": "BENJAMIN",
    "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": "621 ALDERSHOT RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21229-2107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-974-2649",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5054 DORSEY HALL DR STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELLICOTT CITY",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21042-7795",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-893-4600",
    "PracticeLocationAddressFaxNumber": "443-640-4358",
    "EnumerationDate": "01/30/2019",
    "LastUpdateDate": "11/16/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "LGP8781",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LC13221",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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