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1124183637 NPI number — MARY AMEDEO MSW, LICSW

NPI Number: 1124183637
Health Care Provider/Practitioner: MARY AMEDEO MSW, LICSW

Information about “1124183637” NPI (MARY AMEDEO MSW, LICSW) exists in 1124183637 in HTML format HTML  |  1124183637 in plain Text format TXT  |  1124183637 in PDF (Portable Document Format) PDF  |  1124183637 in an XML format XML  formats.

NPI Number : 1124183637 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124183637",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AMEDEO",
    "FirstName": "MARY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "861 SKYLINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN LUIS OBISPO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93405-1039",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-234-0948",
    "MailingAddressFaxNumber": "844-740-0060",
    "FirstLinePracticeLocationAddress": "118 NEVADA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARROYO GRANDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93420-2610",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-234-0948",
    "PracticeLocationAddressFaxNumber": "844-740-0060",
    "EnumerationDate": "12/26/2006",
    "LastUpdateDate": "11/30/2016",
    "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": "212",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW29118",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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