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1225737174 NPI number — TRACY LYNN COLANGELO ACSW, LMSW

NPI Number: 1225737174
Health Care Provider/Practitioner: TRACY LYNN COLANGELO ACSW, LMSW

Information about “1225737174” NPI (TRACY LYNN COLANGELO ACSW, LMSW) exists in 1225737174 in HTML format HTML  |  1225737174 in plain Text format TXT  |  1225737174 in PDF (Portable Document Format) PDF  |  1225737174 in an XML format XML  formats.

NPI Number : 1225737174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225737174",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLANGELO",
    "FirstName": "TRACY",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ACSW, LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COLANGELO",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ACSW, LMSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2414 BROOKHAVEN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CANTON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48188-1690",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-895-5442",
    "MailingAddressFaxNumber": "734-397-9394",
    "FirstLinePracticeLocationAddress": "340 N MAIN ST STE 316",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLYMOUTH",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48170-1290",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-895-5442",
    "PracticeLocationAddressFaxNumber": "734-397-9394",
    "EnumerationDate": "03/01/2023",
    "LastUpdateDate": "03/01/2023",
    "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": "6801064537",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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