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1477800514 NPI number — MELISSA GRAY KENNEDY LCSW

NPI Number: 1477800514
Health Care Provider/Practitioner: MELISSA GRAY KENNEDY LCSW

Information about “1477800514” NPI (MELISSA GRAY KENNEDY LCSW) exists in 1477800514 in HTML format HTML  |  1477800514 in plain Text format TXT  |  1477800514 in PDF (Portable Document Format) PDF  |  1477800514 in an XML format XML  formats.

NPI Number : 1477800514 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477800514",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KENNEDY",
    "FirstName": "MELISSA",
    "MiddleName": "GRAY",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GRAY",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "150 PROVIDENCE RD STE 101",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHAPEL HILL",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27514-2208",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-914-0072",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2515 E NC HIGHWAY 54",
    "SecondLinePracticeLocationAddress": "BULIDING 2200",
    "PracticeLocationAddressCityName": "DURHAM",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27713-5263",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-493-0959",
    "PracticeLocationAddressFaxNumber": "919-493-0970",
    "EnumerationDate": "08/08/2012",
    "LastUpdateDate": "10/10/2024",
    "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": "C009482",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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