1326182924 NPI number — PHILLIP PATRICK LENNON M.S.W., PH.D.

NPI Number: 1326182924
Health Care Provider/Practitioner: PHILLIP PATRICK LENNON M.S.W., PH.D.

NPI Number : 1326182924 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326182924",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LENNON",
    "FirstName": "PHILLIP",
    "MiddleName": "PATRICK",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.S.W., PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LENNON",
    "OtherFirstName": "PATRICK",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PH.D.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 824",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OSWEGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60543-0824",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-901-3223",
    "MailingAddressFaxNumber": "630-375-2932",
    "FirstLinePracticeLocationAddress": "2020 OGDEN AVE",
    "SecondLinePracticeLocationAddress": "SUITE 400",
    "PracticeLocationAddressCityName": "AURORA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60504-5894",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-499-4703",
    "PracticeLocationAddressFaxNumber": "630-375-2932",
    "EnumerationDate": "02/16/2007",
    "LastUpdateDate": "09/25/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "00485",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}