1689050692 NPI number — ANTHONY SIMON M.S.W., L.C.S.W.

NPI Number: 1689050692
Health Care Provider/Practitioner: ANTHONY SIMON M.S.W., L.C.S.W.

NPI Number : 1689050692 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689050692",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SIMON",
    "FirstName": "ANTHONY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S.W., L.C.S.W.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "915 E RAMIE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65202-4436",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-701-9734",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "48-3 YONAHA, SHIMAJIRI DISTRICT",
    "SecondLinePracticeLocationAddress": "ROOM #303",
    "PracticeLocationAddressCityName": "HAEBARU",
    "PracticeLocationAddressStateName": "OKINAWA",
    "PracticeLocationAddressPostalCode": "9011103",
    "PracticeLocationAddressCountryCode": "JP",
    "PracticeLocationAddressTelephoneNumber": "802-134-8359",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/03/2015",
    "LastUpdateDate": "07/21/2022",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW 221191",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW15160",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}