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1104451970 NPI number — LISA ANDREA CAROTHERS LMSW

NPI Number: 1104451970
Health Care Provider/Practitioner: LISA ANDREA CAROTHERS LMSW

Information about “1104451970” NPI (LISA ANDREA CAROTHERS LMSW) exists in 1104451970 in HTML format HTML  |  1104451970 in plain Text format TXT  |  1104451970 in PDF (Portable Document Format) PDF  |  1104451970 in an XML format XML  formats.

NPI Number : 1104451970 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104451970",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CAROTHERS",
    "FirstName": "LISA",
    "MiddleName": "ANDREA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1724 N COOK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPOKANE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99207-5314",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-998-4348",
    "MailingAddressFaxNumber": "509-534-2062",
    "FirstLinePracticeLocationAddress": "1724 N COOK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPOKANE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99207-5314",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-998-4348",
    "PracticeLocationAddressFaxNumber": "509-534-2062",
    "EnumerationDate": "03/11/2020",
    "LastUpdateDate": "04/02/2023",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LCSW-43205",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "LMSW-30939",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW-43205",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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