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1184646150 NPI number — LAURA A CORNELSEN LCSW

NPI Number: 1184646150
Health Care Provider/Practitioner: LAURA A CORNELSEN LCSW

Information about “1184646150” NPI (LAURA A CORNELSEN LCSW) exists in 1184646150 in HTML format HTML  |  1184646150 in plain Text format TXT  |  1184646150 in PDF (Portable Document Format) PDF  |  1184646150 in an XML format XML  formats.

NPI Number : 1184646150 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184646150",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CORNELSEN",
    "FirstName": "LAURA",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HERRMANN",
    "OtherFirstName": "LAURA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "561 RIVER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YARDLEY",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19067-1905",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-720-6277",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "301 OXFORD VALLEY RD",
    "SecondLinePracticeLocationAddress": "SUITE 402B",
    "PracticeLocationAddressCityName": "YARDLEY",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19067-7710",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-720-6277",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/25/2006",
    "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": "CW013759",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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