NPI Code Detail JSON Logo

1215343231 NPI number — MALCOLM ROSE SUSHCHYK LICSW 00012367

NPI Number: 1215343231
Health Care Provider/Practitioner: MALCOLM ROSE SUSHCHYK LICSW 00012367

Information about “1215343231” NPI (MALCOLM ROSE SUSHCHYK LICSW 00012367) exists in 1215343231 in HTML format HTML  |  1215343231 in plain Text format TXT  |  1215343231 in PDF (Portable Document Format) PDF  |  1215343231 in an XML format XML  formats.

NPI Number : 1215343231 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215343231",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SUSHCHYK",
    "FirstName": "MALCOLM",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LICSW 00012367",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "380 BROADWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PROVIDENCE",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02909-1416",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "650-516-6672",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "380 BROADWAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PROVIDENCE",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02909-1416",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "650-516-6672",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/10/2014",
    "LastUpdateDate": "10/28/2025",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "99467",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "ISW03525",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "123679",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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