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1215781083 NPI number — CARMELITA ANN MATT MSW, SWLC

NPI Number: 1215781083
Health Care Provider/Practitioner: CARMELITA ANN MATT MSW, SWLC

Information about “1215781083” NPI (CARMELITA ANN MATT MSW, SWLC) exists in 1215781083 in HTML format HTML  |  1215781083 in plain Text format TXT  |  1215781083 in PDF (Portable Document Format) PDF  |  1215781083 in an XML format XML  formats.

NPI Number : 1215781083 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215781083",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATT",
    "FirstName": "CARMELITA",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, SWLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1144",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ST IGNATIUS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59865-1144",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-214-1426",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1724 FAIRVIEW AVE STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59801-7873",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-214-3810",
    "PracticeLocationAddressFaxNumber": "406-720-7806",
    "EnumerationDate": "04/16/2024",
    "LastUpdateDate": "04/16/2024",
    "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": "BBH-SWLC-LIC-70496",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X 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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