1275144602 NPI number — Synthia Elaina Stewart Licensed Clinical Social Worker

NPI Number: 1275144602
Health Care Provider/Practitioner: Synthia Elaina Stewart Licensed Clinical Social Worker

NPI Number : 1275144602 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275144602",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "Stewart",
    "FirstName": "Synthia",
    "MiddleName": "Elaina",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "Licensed Clinical Social Worker",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "Psychotherapist",
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": null,
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "Venus",
    "MailingAddressStateName": "Texas",
    "MailingAddressPostalCode": "76084",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "8176883229",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": null,
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "Venus",
    "PracticeLocationAddressStateName": "Texas",
    "PracticeLocationAddressPostalCode": "76084",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "8176883229",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/10/2020",
    "LastUpdateDate": "08/10/2020",
    "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": "1041C0700X",
          "LicenseNumber": "59738 ",
          "LicenseNumberStateCode": "Texas",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "1041C0700X",
          "LicenseNumber": "0904010883",
          "LicenseNumberStateCode": "Virginia ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": null,
          "TaxonomyName": "1041C0700X",
          "LicenseNumber": "L10355",
          "LicenseNumberStateCode": "Oregon",
          "PrimaryTaxonomySwitch": null
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}