NPI Code Detail JSON Logo

1205422029 NPI number — KRISTEN N SMITH LMSW

NPI Number: 1205422029
Health Care Provider/Practitioner: KRISTEN N SMITH LMSW

Information about “1205422029” NPI (KRISTEN N SMITH LMSW) exists in 1205422029 in HTML format HTML  |  1205422029 in plain Text format TXT  |  1205422029 in PDF (Portable Document Format) PDF  |  1205422029 in an XML format XML  formats.

NPI Number : 1205422029 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205422029",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "KRISTEN",
    "MiddleName": "N",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EBERSOL",
    "OtherFirstName": "KRISTEN",
    "OtherMiddleName": "N",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5407 BRIDEGEWOOD DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KILLEEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76549-5628",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-778-7908",
    "MailingAddressFaxNumber": "315-785-8628",
    "FirstLinePracticeLocationAddress": "611 WEST MAIN STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13601-2416",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-755-2033",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/16/2020",
    "LastUpdateDate": "09/29/2025",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "110497",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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