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1174627285 NPI number — FAY L MYERS MDIV MSW LCSW

NPI Number: 1174627285
Health Care Provider/Practitioner: FAY L MYERS MDIV MSW LCSW

Information about “1174627285” NPI (FAY L MYERS MDIV MSW LCSW) exists in 1174627285 in HTML format HTML  |  1174627285 in plain Text format TXT  |  1174627285 in PDF (Portable Document Format) PDF  |  1174627285 in an XML format XML  formats.

NPI Number : 1174627285 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174627285",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MYERS",
    "FirstName": "FAY",
    "MiddleName": "L",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MDIV MSW LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "18154 MARTIN AVE",
    "SecondLineMailingAddress": "SUITE 3",
    "MailingAddressCityName": "HOMEWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60430-2653",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-206-2755",
    "MailingAddressFaxNumber": "708-957-9588",
    "FirstLinePracticeLocationAddress": "18154 MARTIN AVE",
    "SecondLinePracticeLocationAddress": "SUITE 3",
    "PracticeLocationAddressCityName": "HOMEWOOD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60430-2653",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-206-2755",
    "PracticeLocationAddressFaxNumber": "708-957-9588",
    "EnumerationDate": "09/11/2006",
    "LastUpdateDate": "07/08/2007",
    "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": null,
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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