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1518641471 NPI number — JESSICA SHANTE GREEN LMSW

NPI Number: 1518641471
Health Care Provider/Practitioner: JESSICA SHANTE GREEN LMSW

Information about “1518641471” NPI (JESSICA SHANTE GREEN LMSW) exists in 1518641471 in HTML format HTML  |  1518641471 in plain Text format TXT  |  1518641471 in PDF (Portable Document Format) PDF  |  1518641471 in an XML format XML  formats.

NPI Number : 1518641471 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518641471",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GREEN",
    "FirstName": "JESSICA",
    "MiddleName": "SHANTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "950 S GEORGE MASON DR APT 714",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARLINGTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22204-1864",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-329-7050",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1208 E CHURCHVILLE RD STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEL AIR",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21014-3485",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-893-4600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2023",
    "LastUpdateDate": "06/30/2023",
    "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": "MSW010482",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "0903003712",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "30282",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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