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1366783938 NPI number — DEANNE RENEE' BOLDEN LMSW

NPI Number: 1366783938
Health Care Provider/Practitioner: DEANNE RENEE' BOLDEN LMSW

Information about “1366783938” NPI (DEANNE RENEE' BOLDEN LMSW) exists in 1366783938 in HTML format HTML  |  1366783938 in plain Text format TXT  |  1366783938 in PDF (Portable Document Format) PDF  |  1366783938 in an XML format XML  formats.

NPI Number : 1366783938 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366783938",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOLDEN",
    "FirstName": "DEANNE",
    "MiddleName": "RENEE'",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCGOWAN",
    "OtherFirstName": "DEANNE",
    "OtherMiddleName": "RENEE'",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LMSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "29323 CANDLEWOOD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48076-1867",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-445-1801",
    "MailingAddressFaxNumber": "313-251-2774",
    "FirstLinePracticeLocationAddress": "17515 W 9 MILE RD STE 755",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHFIELD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48075-4422",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-499-4312",
    "PracticeLocationAddressFaxNumber": "248-721-4936",
    "EnumerationDate": "03/07/2013",
    "LastUpdateDate": "05/01/2025",
    "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": "6801093858",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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