NPI Code Detail JSON Logo

1306099213 NPI number — TINA HUBBARD LCSW-R

NPI Number: 1306099213
Health Care Provider/Practitioner: TINA HUBBARD LCSW-R

Information about “1306099213” NPI (TINA HUBBARD LCSW-R) exists in 1306099213 in HTML format HTML  |  1306099213 in plain Text format TXT  |  1306099213 in PDF (Portable Document Format) PDF  |  1306099213 in an XML format XML  formats.

NPI Number : 1306099213 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306099213",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HUBBARD",
    "FirstName": "TINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW-R",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATEVISH",
    "OtherFirstName": "TINA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "275 PARRISH ST",
    "SecondLineMailingAddress": "STE A",
    "MailingAddressCityName": "CANANDAIGUA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14424-1785",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "585-412-9187",
    "MailingAddressFaxNumber": "585-310-8514",
    "FirstLinePracticeLocationAddress": "275 PARRISH ST",
    "SecondLinePracticeLocationAddress": "STE A",
    "PracticeLocationAddressCityName": "CANANDAIGUA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14424-1785",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "585-412-9187",
    "PracticeLocationAddressFaxNumber": "585-310-8514",
    "EnumerationDate": "10/23/2008",
    "LastUpdateDate": "11/17/2017",
    "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": "73076282",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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