1124394671 NPI number — SUSAN HARTMAN BRENIZER M.A., LMFT (LICENSED

NPI Number: 1124394671
Health Care Provider/Practitioner: SUSAN HARTMAN BRENIZER M.A., LMFT (LICENSED

NPI Number : 1124394671 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124394671",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRENIZER",
    "FirstName": "SUSAN",
    "MiddleName": "HARTMAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A., LMFT (LICENSED",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HARTMAN",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.A., LMFT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A",
    "SecondLineMailingAddress": "SECOND FLOOR (UPPER LEVEL)",
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13066",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-446-9646",
    "MailingAddressFaxNumber": "315-637-6264",
    "FirstLinePracticeLocationAddress": "7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A",
    "SecondLinePracticeLocationAddress": "SECOND FLOOR (UPPER LEVEL)",
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13066",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-446-9646",
    "PracticeLocationAddressFaxNumber": "315-637-6264",
    "EnumerationDate": "03/29/2012",
    "LastUpdateDate": "03/29/2012",
    "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": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": "NYSTATE#000-425",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}