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1124328604 NPI number — DEBORAH L TANNENBAUM MSW, LCSW

NPI Number: 1124328604
Health Care Provider/Practitioner: DEBORAH L TANNENBAUM MSW, LCSW

Information about “1124328604” NPI (DEBORAH L TANNENBAUM MSW, LCSW) exists in 1124328604 in HTML format HTML  |  1124328604 in plain Text format TXT  |  1124328604 in PDF (Portable Document Format) PDF  |  1124328604 in an XML format XML  formats.

NPI Number : 1124328604 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124328604",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TANNENBAUM",
    "FirstName": "DEBORAH",
    "MiddleName": "L",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MSW, LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FREDMAN",
    "OtherFirstName": "DEBORAH",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3000 ARROW ROCK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT CHARLES",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63303-6502",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-303-2762",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4625 LINDELL BLVD FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63108-3739",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-486-6356",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/29/2010",
    "LastUpdateDate": "09/30/2020",
    "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": "004936",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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