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1134567589 NPI number — TERESA FATEMAH FENNELL MS LCSWA

NPI Number: 1134567589
Health Care Provider/Practitioner: TERESA FATEMAH FENNELL MS LCSWA

Information about “1134567589” NPI (TERESA FATEMAH FENNELL MS LCSWA) exists in 1134567589 in HTML format HTML  |  1134567589 in plain Text format TXT  |  1134567589 in PDF (Portable Document Format) PDF  |  1134567589 in an XML format XML  formats.

NPI Number : 1134567589 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134567589",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FENNELL",
    "FirstName": "TERESA",
    "MiddleName": "FATEMAH",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MS LCSWA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12506 ATKINS CIRCLE DR",
    "SecondLineMailingAddress": "APT 320",
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28277-0037",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-726-3885",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8801 J M KEYNES DR",
    "SecondLinePracticeLocationAddress": "SUITE 440",
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28262-8436",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-537-9551",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/07/2013",
    "LastUpdateDate": "09/09/2013",
    "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": "P007168",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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