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1396443958 NPI number — ALEXANDER JACKSON MCKILLOP LCSW

NPI Number: 1396443958
Health Care Provider/Practitioner: ALEXANDER JACKSON MCKILLOP LCSW

Information about “1396443958” NPI (ALEXANDER JACKSON MCKILLOP LCSW) exists in 1396443958 in HTML format HTML  |  1396443958 in plain Text format TXT  |  1396443958 in PDF (Portable Document Format) PDF  |  1396443958 in an XML format XML  formats.

NPI Number : 1396443958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396443958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCKILLOP",
    "FirstName": "ALEXANDER",
    "MiddleName": "JACKSON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCKILLOP",
    "OtherFirstName": "JACK",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "11 MARCY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT SINAI",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11766-2213",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-905-7632",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11 MARCY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT SINAI",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11766-2213",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-905-7632",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/22/2023",
    "LastUpdateDate": "02/22/2023",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "094674",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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