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1215993746 NPI number — KATHLEEN B. PAE LPC

NPI Number: 1215993746
Health Care Provider/Practitioner: KATHLEEN B. PAE LPC

Information about “1215993746” NPI (KATHLEEN B. PAE LPC) exists in 1215993746 in HTML format HTML  |  1215993746 in plain Text format TXT  |  1215993746 in PDF (Portable Document Format) PDF  |  1215993746 in an XML format XML  formats.

NPI Number : 1215993746 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215993746",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAE",
    "FirstName": "KATHLEEN",
    "MiddleName": "B.",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLACKBURN",
    "OtherFirstName": "KATHLEEN",
    "OtherMiddleName": "A.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, LPC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3800 WEST 12TH STREET",
    "SecondLineMailingAddress": "STE 5",
    "MailingAddressCityName": "ERIE",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "16505-3380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-838-2282",
    "MailingAddressFaxNumber": "814-969-7730",
    "FirstLinePracticeLocationAddress": "3800 WEST 12TH STREET",
    "SecondLinePracticeLocationAddress": "STE 5",
    "PracticeLocationAddressCityName": "ERIE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16505-3380",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-838-2282",
    "PracticeLocationAddressFaxNumber": "814-969-7730",
    "EnumerationDate": "04/24/2006",
    "LastUpdateDate": "11/09/2022",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "CAC NUMBER  0512",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "PC000654",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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