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1710052618 NPI number — MIRANDA RAE FANI SROUR LICSW

NPI Number: 1710052618
Health Care Provider/Practitioner: MIRANDA RAE FANI SROUR LICSW

Information about “1710052618” NPI (MIRANDA RAE FANI SROUR LICSW) exists in 1710052618 in HTML format HTML  |  1710052618 in plain Text format TXT  |  1710052618 in PDF (Portable Document Format) PDF  |  1710052618 in an XML format XML  formats.

NPI Number : 1710052618 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710052618",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FANI SROUR",
    "FirstName": "MIRANDA",
    "MiddleName": "RAE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MYERS",
    "OtherFirstName": "MIRANDA",
    "OtherMiddleName": "RAE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4 MERRY MEETING LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RYE",
    "MailingAddressStateName": "NH",
    "MailingAddressPostalCode": "03870-2325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-504-5737",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1145 SAGAMORE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTSMOUTH",
    "PracticeLocationAddressStateName": "NH",
    "PracticeLocationAddressPostalCode": "03801-5585",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "603-431-6703",
    "PracticeLocationAddressFaxNumber": "603-430-3753",
    "EnumerationDate": "11/24/2006",
    "LastUpdateDate": "09/20/2018",
    "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": "115136",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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