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1346654399 NPI number — EDWARD GONZALEZ LCSW & LDAC

NPI Number: 1346654399
Health Care Provider/Practitioner: EDWARD GONZALEZ LCSW & LDAC

Information about “1346654399” NPI (EDWARD GONZALEZ LCSW & LDAC) exists in 1346654399 in HTML format HTML  |  1346654399 in plain Text format TXT  |  1346654399 in PDF (Portable Document Format) PDF  |  1346654399 in an XML format XML  formats.

NPI Number : 1346654399 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346654399",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONZALEZ",
    "FirstName": "EDWARD",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW & LDAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1329 BURNSIDE AVE APT B3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST HARTFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06108-1575",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-652-2100",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "627 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06040-5181",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-324-0042",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/18/2014",
    "LastUpdateDate": "05/12/2022",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "1090",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "010279",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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