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1114191426 NPI number — JULIE ANNA MALL PSY.21501D

NPI Number: 1114191426
Health Care Provider/Practitioner: JULIE ANNA MALL PSY.21501D

Information about “1114191426” NPI (JULIE ANNA MALL PSY.21501D) exists in 1114191426 in HTML format HTML  |  1114191426 in plain Text format TXT  |  1114191426 in PDF (Portable Document Format) PDF  |  1114191426 in an XML format XML  formats.

NPI Number : 1114191426 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114191426",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MALL",
    "FirstName": "JULIE",
    "MiddleName": "ANNA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PSY.21501D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "432 TORTOISE VIEW CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SATELLITE BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32937-3801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "432 TORTOISE VIEW CIRCLE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SATELLITE BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32937-3801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "321-432-2865",
    "PracticeLocationAddressFaxNumber": "321-777-5806",
    "EnumerationDate": "04/17/2008",
    "LastUpdateDate": "10/26/2021",
    "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": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PY6653",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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