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1629639992 NPI number — ALAN LEROY MCBROOM ASWCM

NPI Number: 1629639992
Health Care Provider/Practitioner: ALAN LEROY MCBROOM ASWCM

Information about “1629639992” NPI (ALAN LEROY MCBROOM ASWCM) exists in 1629639992 in HTML format HTML  |  1629639992 in plain Text format TXT  |  1629639992 in PDF (Portable Document Format) PDF  |  1629639992 in an XML format XML  formats.

NPI Number : 1629639992 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629639992",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCBROOM",
    "FirstName": "ALAN",
    "MiddleName": "LEROY",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "ASWCM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "24681 NORTHWESTERN HWY STE 307",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48075-2322",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-355-1980",
    "MailingAddressFaxNumber": "248-355-0362",
    "FirstLinePracticeLocationAddress": "24681 NORTHWESTERN HWY",
    "SecondLinePracticeLocationAddress": "STE 3001",
    "PracticeLocationAddressCityName": "SOUTHFIELD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48075-2305",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-355-1980",
    "PracticeLocationAddressFaxNumber": "248-355-0362",
    "EnumerationDate": "06/26/2019",
    "LastUpdateDate": "09/29/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "6801015680",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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