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1356319784 NPI number — LINDA C. TILLMON MSW

NPI Number: 1356319784
Health Care Provider/Practitioner: LINDA C. TILLMON MSW

Information about “1356319784” NPI (LINDA C. TILLMON MSW) exists in 1356319784 in HTML format HTML  |  1356319784 in plain Text format TXT  |  1356319784 in PDF (Portable Document Format) PDF  |  1356319784 in an XML format XML  formats.

NPI Number : 1356319784 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356319784",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TILLMON",
    "FirstName": "LINDA",
    "MiddleName": "C.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2590 FRISBY AVE STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRONX",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10461-3240",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-239-1610",
    "MailingAddressFaxNumber": "718-792-7053",
    "FirstLinePracticeLocationAddress": "140 ERDMAN PL APT 15F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRONX",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10475-5312",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-423-8795",
    "PracticeLocationAddressFaxNumber": "929-286-9775",
    "EnumerationDate": "03/10/2006",
    "LastUpdateDate": "09/13/2022",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "069485",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "076822",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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