NPI Code Detail JSON Logo

1114266731 NPI number — CHRISTAN LATONYA BENNETT MSW, LCSW

NPI Number: 1114266731
Health Care Provider/Practitioner: CHRISTAN LATONYA BENNETT MSW, LCSW

Information about “1114266731” NPI (CHRISTAN LATONYA BENNETT MSW, LCSW) exists in 1114266731 in HTML format HTML  |  1114266731 in plain Text format TXT  |  1114266731 in PDF (Portable Document Format) PDF  |  1114266731 in an XML format XML  formats.

NPI Number : 1114266731 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114266731",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BENNETT",
    "FirstName": "CHRISTAN",
    "MiddleName": "LATONYA",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MSW, LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BENNETT",
    "OtherFirstName": "CHRISTAN",
    "OtherMiddleName": "LATONYA",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MSW, LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1589 MOUNTAIN LAKE DR E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32221-5548",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-337-9073",
    "MailingAddressFaxNumber": "904-337-4448",
    "FirstLinePracticeLocationAddress": "1589 MOUNTAIN LAKE DR E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32221-5548",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-337-9073",
    "PracticeLocationAddressFaxNumber": "904-337-4448",
    "EnumerationDate": "02/01/2013",
    "LastUpdateDate": "11/24/2024",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "160994624",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW13712",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.