1366846354 NPI number — MICHELLE SANDERS L.C.S.W

NPI Number: 1366846354
Health Care Provider/Practitioner: MICHELLE SANDERS L.C.S.W

NPI Number : 1366846354 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366846354",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANDERS",
    "FirstName": "MICHELLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.C.S.W",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "110 TANDBERG TRL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINDHAM",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04062-5206",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-653-9349",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1749 VICTORY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATEN ISLAND",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10314-3552",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-764-8278",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/20/2014",
    "LastUpdateDate": "11/25/2025",
    "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": "LC21756",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "092981-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}