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1235184920 NPI number — ELAINE BANTA PHD PA

NPI Number: 1235184920
Health Care Provider/Practitioner: ELAINE BANTA PHD PA

Information about “1235184920” NPI (ELAINE BANTA PHD PA) exists in 1235184920 in HTML format HTML  |  1235184920 in plain Text format TXT  |  1235184920 in PDF (Portable Document Format) PDF  |  1235184920 in an XML format XML  formats.

NPI Number : 1235184920 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235184920",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ELAINE BANTA PHD PA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "725 NA1A",
    "SecondLineMailingAddress": "ELAINE BANTA PHD PA STE B106",
    "MailingAddressCityName": "JUPITER",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33477",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-427-0144",
    "MailingAddressFaxNumber": "561-747-0258",
    "FirstLinePracticeLocationAddress": "725 NA1A",
    "SecondLinePracticeLocationAddress": "ELAINE BANTA PHD PA STE B106",
    "PracticeLocationAddressCityName": "JUPITER",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33477",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-427-0144",
    "PracticeLocationAddressFaxNumber": "561-747-0258",
    "EnumerationDate": "05/23/2006",
    "LastUpdateDate": "12/05/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BANTA",
    "AuthorizedOfficialFirstName": "ELAINE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "561-427-0144",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "NC1669NC",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PY4354FL",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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