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1215915582 NPI number — MARYBETH GRAS LCSW

NPI Number: 1215915582
Health Care Provider/Practitioner: MARYBETH GRAS LCSW

Information about “1215915582” NPI (MARYBETH GRAS LCSW) exists in 1215915582 in HTML format HTML  |  1215915582 in plain Text format TXT  |  1215915582 in PDF (Portable Document Format) PDF  |  1215915582 in an XML format XML  formats.

NPI Number : 1215915582 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215915582",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRAS",
    "FirstName": "MARYBETH",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4200 SHENANDOAH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63110-3513",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-629-9862",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4625 LINDELL BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 315",
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63108-3729",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-629-9862",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/05/2006",
    "LastUpdateDate": "11/08/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/27/2023",
    "NPIReactivationDate": "11/08/2023",
    "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": "2001022248",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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