NPI Code Detail JSON Logo

1194080895 NPI number — DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.

NPI Number: 1194080895
Health Care Provider/Practitioner: DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.

Information about “1194080895” NPI (DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.) exists in 1194080895 in HTML format HTML  |  1194080895 in plain Text format TXT  |  1194080895 in PDF (Portable Document Format) PDF  |  1194080895 in an XML format XML  formats.

NPI Number : 1194080895 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194080895",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2584 GOVERNORS CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARIANNA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32446-6399",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-443-9801",
    "MailingAddressFaxNumber": "850-893-6013",
    "FirstLinePracticeLocationAddress": "4284 KELSON AVE.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARIANNA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32446-6399",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-443-9801",
    "PracticeLocationAddressFaxNumber": "850-526-3349",
    "EnumerationDate": "07/09/2012",
    "LastUpdateDate": "07/18/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DEBRAUWERE",
    "AuthorizedOfficialFirstName": "DOMINICA",
    "AuthorizedOfficialMiddleName": "J.",
    "AuthorizedOfficialTitle": "THERAPIST/PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSW, LCSW, DCSW",
    "AuthorizedOfficialTelephoneNumber": "850-443-9801",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW 3307",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "3307",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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