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1255809240 NPI number — MICHELLE ANN ENSRUD LAM LCSW

NPI Number: 1255809240
Health Care Provider/Practitioner: MICHELLE ANN ENSRUD LAM LCSW

Information about “1255809240” NPI (MICHELLE ANN ENSRUD LAM LCSW) exists in 1255809240 in HTML format HTML  |  1255809240 in plain Text format TXT  |  1255809240 in PDF (Portable Document Format) PDF  |  1255809240 in an XML format XML  formats.

NPI Number : 1255809240 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255809240",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LAM",
    "FirstName": "MICHELLE",
    "MiddleName": "ANN ENSRUD",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LAM",
    "OtherFirstName": "MICHELLE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3305 KINFOLK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERNDON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20171-4011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-220-3002",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4460 BROOKFIELD CORPORATE DR STE H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHANTILLY",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20151-1671",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-933-8151",
    "PracticeLocationAddressFaxNumber": "571-933-8438",
    "EnumerationDate": "11/07/2018",
    "LastUpdateDate": "01/06/2020",
    "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": "0904010770",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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