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1124630355 NPI number — KELLY THERESA BOCCIO MA, NCC, LAC

NPI Number: 1124630355
Health Care Provider/Practitioner: KELLY THERESA BOCCIO MA, NCC, LAC

Information about “1124630355” NPI (KELLY THERESA BOCCIO MA, NCC, LAC) exists in 1124630355 in HTML format HTML  |  1124630355 in plain Text format TXT  |  1124630355 in PDF (Portable Document Format) PDF  |  1124630355 in an XML format XML  formats.

NPI Number : 1124630355 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124630355",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOCCIO",
    "FirstName": "KELLY",
    "MiddleName": "THERESA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, NCC, LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "32 POWELL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALLENDALE",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07401-2011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-619-5454",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "79 N FRANKLIN TPKE STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RAMSEY",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07446-2029",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "973-477-5480",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/19/2020",
    "LastUpdateDate": "08/19/2020",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "37AC00531400",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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