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1639516156 NPI number — MRS. GINA MARIE LATTY

NPI Number: 1639516156
Health Care Provider/Practitioner: MRS. GINA MARIE LATTY

Information about “1639516156” NPI (MRS. GINA MARIE LATTY) exists in 1639516156 in HTML format HTML  |  1639516156 in plain Text format TXT  |  1639516156 in PDF (Portable Document Format) PDF  |  1639516156 in an XML format XML  formats.

NPI Number : 1639516156 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639516156",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LATTY",
    "FirstName": "GINA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KEATING",
    "OtherFirstName": "GINA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2806 DAVENPORT AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAGINAW",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48602-3734",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-790-7500",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "304 S NIAGARA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAGINAW",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48602",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-799-5642",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/23/2013",
    "LastUpdateDate": "04/14/2023",
    "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": "6801092117",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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