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1265681241 NPI number — ERIN E MCCORMACK LCSW

NPI Number: 1265681241
Health Care Provider/Practitioner: ERIN E MCCORMACK LCSW

Information about “1265681241” NPI (ERIN E MCCORMACK LCSW) exists in 1265681241 in HTML format HTML  |  1265681241 in plain Text format TXT  |  1265681241 in PDF (Portable Document Format) PDF  |  1265681241 in an XML format XML  formats.

NPI Number : 1265681241 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265681241",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCORMACK",
    "FirstName": "ERIN",
    "MiddleName": "E",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCCORMACK",
    "OtherFirstName": "ERIN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "30 MAIN ST",
    "SecondLineMailingAddress": "FL 1",
    "MailingAddressCityName": "EAST HAVEN",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06512-2506",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-927-5130",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1309 S MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERBURY",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06706-1758",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-756-8021",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/15/2008",
    "LastUpdateDate": "04/06/2021",
    "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": "006565",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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