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1609826106 NPI number — IRIS JUNE BERNAU MSW LCSW ACSW BCD

NPI Number: 1609826106
Health Care Provider/Practitioner: IRIS JUNE BERNAU MSW LCSW ACSW BCD

Information about “1609826106” NPI (IRIS JUNE BERNAU MSW LCSW ACSW BCD) exists in 1609826106 in HTML format HTML  |  1609826106 in plain Text format TXT  |  1609826106 in PDF (Portable Document Format) PDF  |  1609826106 in an XML format XML  formats.

NPI Number : 1609826106 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609826106",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERNAU",
    "FirstName": "IRIS",
    "MiddleName": "JUNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW LCSW ACSW BCD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "501 OCEAN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW LONDON",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06320",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-442-6364",
    "MailingAddressFaxNumber": "860-447-9977",
    "FirstLinePracticeLocationAddress": "501 OCEAN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW LONDON",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06320",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-442-6364",
    "PracticeLocationAddressFaxNumber": "860-447-9977",
    "EnumerationDate": "05/12/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "002087",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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