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1609557032 NPI number — PHOEBE WAKEROBIN SHELDON YOUNG MSW

NPI Number: 1609557032
Health Care Provider/Practitioner: PHOEBE WAKEROBIN SHELDON YOUNG MSW

Information about “1609557032” NPI (PHOEBE WAKEROBIN SHELDON YOUNG MSW) exists in 1609557032 in HTML format HTML  |  1609557032 in plain Text format TXT  |  1609557032 in PDF (Portable Document Format) PDF  |  1609557032 in an XML format XML  formats.

NPI Number : 1609557032 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609557032",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHELDON YOUNG",
    "FirstName": "PHOEBE",
    "MiddleName": "WAKEROBIN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1660 OLD PECOS TRL STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA FE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87505-4778",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-657-9708",
    "MailingAddressFaxNumber": "505-395-9295",
    "FirstLinePracticeLocationAddress": "1660 OLD PECOS TRL STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA FE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87505-4778",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-657-9708",
    "PracticeLocationAddressFaxNumber": "505-395-9295",
    "EnumerationDate": "07/27/2023",
    "LastUpdateDate": "07/27/2023",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "SWB-2023-0298",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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