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1609231711 NPI number — NANCY FADER MFT

NPI Number: 1609231711
Health Care Provider/Practitioner: NANCY FADER MFT

Information about “1609231711” NPI (NANCY FADER MFT) exists in 1609231711 in HTML format HTML  |  1609231711 in plain Text format TXT  |  1609231711 in PDF (Portable Document Format) PDF  |  1609231711 in an XML format XML  formats.

NPI Number : 1609231711 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609231711",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FADER",
    "FirstName": "NANCY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1085 12TH ST UNIT C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IMPERIAL BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91932-2948",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-823-9782",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "106 THORN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92103-5629",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-431-0046",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2015",
    "LastUpdateDate": "03/14/2020",
    "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": "171000000X",
          "TaxonomyName": "Military Health Care Provider",
          "LicenseNumber": "95040",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "95040",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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