NPI Code Detail JSON Logo

1366103202 NPI number — A'SA MARIAH FERNANDEZ EVANS LMSW

NPI Number: 1366103202
Health Care Provider/Practitioner: A'SA MARIAH FERNANDEZ EVANS LMSW

Information about “1366103202” NPI (A'SA MARIAH FERNANDEZ EVANS LMSW) exists in 1366103202 in HTML format HTML  |  1366103202 in plain Text format TXT  |  1366103202 in PDF (Portable Document Format) PDF  |  1366103202 in an XML format XML  formats.

NPI Number : 1366103202 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366103202",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FERNANDEZ EVANS",
    "FirstName": "A'SA",
    "MiddleName": "MARIAH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EVANS",
    "OtherFirstName": "A'SA",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1317 MONTERREY BLVD APT 134A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EULESS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76040-8181",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "682-386-6575",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9407 MIDWAY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75220-3850",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-353-8804",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/03/2022",
    "LastUpdateDate": "11/06/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/28/2024",
    "NPIReactivationDate": "11/06/2024",
    "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": "114148",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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