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1710523774 NPI number — LISA DIANE BROWN LCSW

NPI Number: 1710523774
Health Care Provider/Practitioner: LISA DIANE BROWN LCSW

Information about “1710523774” NPI (LISA DIANE BROWN LCSW) exists in 1710523774 in HTML format HTML  |  1710523774 in plain Text format TXT  |  1710523774 in PDF (Portable Document Format) PDF  |  1710523774 in an XML format XML  formats.

NPI Number : 1710523774 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710523774",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROWN",
    "FirstName": "LISA",
    "MiddleName": "DIANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CROEKER",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "DIANE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "E7475 RAWHIDE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW LONDON",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54961-9025",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "W3950 WI-23 TRUNK",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FOND DU LAC",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54937",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-300-9101",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/25/2019",
    "LastUpdateDate": "11/25/2019",
    "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": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "13056-120",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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