{
"Npi": {
"NPI": "1104645720",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GIVENS",
"FirstName": "JENNIFER",
"MiddleName": "ANDREA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12987 MORENO BEACH DR APT 14305",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORENO VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92555-4443",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-754-3659",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3281 E GUASTI RD STE 440",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ONTARIO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91761-7635",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-705-6354",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/09/2024",
"LastUpdateDate": "10/09/2024",
"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": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}