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1144621319 NPI number — MEGAN LYNN MARIE CANNON LCSW

NPI Number: 1144621319
Health Care Provider/Practitioner: MEGAN LYNN MARIE CANNON LCSW

Information about “1144621319” NPI (MEGAN LYNN MARIE CANNON LCSW) exists in 1144621319 in HTML format HTML  |  1144621319 in plain Text format TXT  |  1144621319 in PDF (Portable Document Format) PDF  |  1144621319 in an XML format XML  formats.

NPI Number : 1144621319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144621319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CANNON",
    "FirstName": "MEGAN",
    "MiddleName": "LYNN MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HOFFMAN",
    "OtherFirstName": "MEGAN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "418 ALHAMBRA BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95816-3362",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-573-4456",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "418 ALHAMBRA BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95816-3362",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-573-4456",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/08/2014",
    "LastUpdateDate": "04/30/2024",
    "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": "TPSW3262",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW81032",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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