1710425087 NPI number — JUAN FARAONI III PSYA.D., LPC, LMHC

NPI Number: 1710425087
Health Care Provider/Practitioner: JUAN FARAONI III PSYA.D., LPC, LMHC

NPI Number : 1710425087 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710425087",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FARAONI",
    "FirstName": "JUAN",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": "III",
    "Credential": "PSYA.D., LPC, LMHC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "115 EDGEMERE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST HARTFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06110-1003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-908-1228",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "660 PROSPECT AVE STE 301",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HARTFORD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06105-4230",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-400-2428",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/07/2017",
    "LastUpdateDate": "09/03/2024",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "MH20181",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "11153",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "3078",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}