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1548673387 NPI number — JASON NICHOLSEN LICSW

NPI Number: 1548673387
Health Care Provider/Practitioner: JASON NICHOLSEN LICSW

Information about “1548673387” NPI (JASON NICHOLSEN LICSW) exists in 1548673387 in HTML format HTML  |  1548673387 in plain Text format TXT  |  1548673387 in PDF (Portable Document Format) PDF  |  1548673387 in an XML format XML  formats.

NPI Number : 1548673387 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548673387",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICHOLSEN",
    "FirstName": "JASON",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "218 20TH ST NE",
    "SecondLineMailingAddress": "#1",
    "MailingAddressCityName": "WASHINGTON",
    "MailingAddressStateName": "DC",
    "MailingAddressPostalCode": "20002-6752",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "347-834-3781",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2301 MARTIN LUTHER KING JR AVE SE",
    "SecondLinePracticeLocationAddress": "WHITMAN WALKER HEALTH",
    "PracticeLocationAddressCityName": "WASHINGTON",
    "PracticeLocationAddressStateName": "DC",
    "PracticeLocationAddressPostalCode": "20020-5813",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-834-3781",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/10/2014",
    "LastUpdateDate": "02/27/2017",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "LG50081076",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LC50080958",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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