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1124491089 NPI number — SANDRA PATRICIA JACO O'BRIEN LICSW

NPI Number: 1124491089
Health Care Provider/Practitioner: SANDRA PATRICIA JACO O'BRIEN LICSW

Information about “1124491089” NPI (SANDRA PATRICIA JACO O'BRIEN LICSW) exists in 1124491089 in HTML format HTML  |  1124491089 in plain Text format TXT  |  1124491089 in PDF (Portable Document Format) PDF  |  1124491089 in an XML format XML  formats.

NPI Number : 1124491089 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124491089",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACO O'BRIEN",
    "FirstName": "SANDRA",
    "MiddleName": "PATRICIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACO",
    "OtherFirstName": "SANDRA",
    "OtherMiddleName": "PATRICIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LICSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 554",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TYNGSBORO",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01879-0554",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "537 KING ST FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LITTLETON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01460-1211",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-649-6452",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/01/2015",
    "LastUpdateDate": "11/01/2015",
    "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": "1027630",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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