NPI Code Detail JSON Logo

1114090701 NPI number — JENNELL MAZE LCSW

NPI Number: 1114090701
Health Care Provider/Practitioner: JENNELL MAZE LCSW

Information about “1114090701” NPI (JENNELL MAZE LCSW) exists in 1114090701 in HTML format HTML  |  1114090701 in plain Text format TXT  |  1114090701 in PDF (Portable Document Format) PDF  |  1114090701 in an XML format XML  formats.

NPI Number : 1114090701 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114090701",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAZE",
    "FirstName": "JENNELL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "31450 BROAD BEACH RD.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MALIBU",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90265",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-430-8882",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11080 W OLYMPIC BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90064-1937",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-966-6656",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2006",
    "LastUpdateDate": "01/11/2022",
    "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": "LCSW 26309",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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