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1568687796 NPI number — PAULA BLUMBERG ALICE BLUMBERG LICSW

NPI Number: 1568687796
Health Care Provider/Practitioner: PAULA BLUMBERG ALICE BLUMBERG LICSW

Information about “1568687796” NPI (PAULA BLUMBERG ALICE BLUMBERG LICSW) exists in 1568687796 in HTML format HTML  |  1568687796 in plain Text format TXT  |  1568687796 in PDF (Portable Document Format) PDF  |  1568687796 in an XML format XML  formats.

NPI Number : 1568687796 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568687796",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLUMBERG",
    "FirstName": "PAULA BLUMBERG",
    "MiddleName": "ALICE",
    "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": "46 PINE RIDGE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WABAN",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02468-1617",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-969-3067",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2184 WASHINGTON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CANTON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02021-1145",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "781-821-0460",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2007",
    "LastUpdateDate": "07/09/2007",
    "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": "102275",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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