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1215098850 NPI number — GREGORY ROBERT ROLNICK MA

NPI Number: 1215098850
Health Care Provider/Practitioner: GREGORY ROBERT ROLNICK MA

Information about “1215098850” NPI (GREGORY ROBERT ROLNICK MA) exists in 1215098850 in HTML format HTML  |  1215098850 in plain Text format TXT  |  1215098850 in PDF (Portable Document Format) PDF  |  1215098850 in an XML format XML  formats.

NPI Number : 1215098850 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215098850",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROLNICK",
    "FirstName": "GREGORY",
    "MiddleName": "ROBERT",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "840 SE 8TH AVE",
    "SecondLineMailingAddress": "SUITE 204",
    "MailingAddressCityName": "OAK HARBOR",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98277",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-679-2020",
    "MailingAddressFaxNumber": "360-679-2020",
    "FirstLinePracticeLocationAddress": "840 SE 8TH AVE",
    "SecondLinePracticeLocationAddress": "SUITE 204",
    "PracticeLocationAddressCityName": "OAK HARBOR",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98277",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-679-2020",
    "PracticeLocationAddressFaxNumber": "360-679-2020",
    "EnumerationDate": "12/13/2006",
    "LastUpdateDate": "11/19/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC2200X",
          "TaxonomyName": "Clinical Child & Adolescent Psychologist",
          "LicenseNumber": "LF00001070",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LF00001070",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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