NPI Code Detail JSON Logo

1467064972 NPI number — EDWARD JUSTIN MODESTINO PH.D.

NPI Number: 1467064972
Health Care Provider/Practitioner: EDWARD JUSTIN MODESTINO PH.D.

Information about “1467064972” NPI (EDWARD JUSTIN MODESTINO PH.D.) exists in 1467064972 in HTML format HTML  |  1467064972 in plain Text format TXT  |  1467064972 in PDF (Portable Document Format) PDF  |  1467064972 in an XML format XML  formats.

NPI Number : 1467064972 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467064972",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MODESTINO",
    "FirstName": "EDWARD",
    "MiddleName": "JUSTIN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1044 CENTRAL ST FL 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STOUGHTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02072-4423",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "781-975-2185",
    "MailingAddressFaxNumber": "781-341-4489",
    "FirstLinePracticeLocationAddress": "1044 CENTRAL ST FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOUGHTON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02072-4423",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "781-975-2185",
    "PracticeLocationAddressFaxNumber": "781-341-4489",
    "EnumerationDate": "08/18/2020",
    "LastUpdateDate": "08/15/2024",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "MHC01717",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LMHC10002001",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.