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1417679473 NPI number — COURTNEY JACKSON LMSW

NPI Number: 1417679473
Health Care Provider/Practitioner: COURTNEY JACKSON LMSW

Information about “1417679473” NPI (COURTNEY JACKSON LMSW) exists in 1417679473 in HTML format HTML  |  1417679473 in plain Text format TXT  |  1417679473 in PDF (Portable Document Format) PDF  |  1417679473 in an XML format XML  formats.

NPI Number : 1417679473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417679473",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "COURTNEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON-TROUPE",
    "OtherFirstName": "COURTNEY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "LMSW",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "211 COLLINGWOOD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCHESTER",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14621-1016",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "585-472-6253",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4115 LAKE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROCHESTER",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14612-4813",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "585-324-9273",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/16/2022",
    "LastUpdateDate": "09/16/2022",
    "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": "109152-01",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "109152-01",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041S0200X",
          "TaxonomyName": "School Social Worker",
          "LicenseNumber": "109152-01",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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