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1568572782 NPI number — JENOA BRIAR-BONPANE LICSW

NPI Number: 1568572782
Health Care Provider/Practitioner: JENOA BRIAR-BONPANE LICSW

Information about “1568572782” NPI (JENOA BRIAR-BONPANE LICSW) exists in 1568572782 in HTML format HTML  |  1568572782 in plain Text format TXT  |  1568572782 in PDF (Portable Document Format) PDF  |  1568572782 in an XML format XML  formats.

NPI Number : 1568572782 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568572782",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRIAR-BONPANE",
    "FirstName": "JENOA",
    "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": "PO BOX 47",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PETROLIA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95558-0047",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-599-0310",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "801 CRESCENT WAY",
    "SecondLinePracticeLocationAddress": "#3",
    "PracticeLocationAddressCityName": "ARCATA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95521-6780",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-599-0310",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/30/2006",
    "LastUpdateDate": "02/09/2010",
    "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": "LW00008001",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCS25914",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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