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1710629258 NPI number — LISA MARIE MUNN MS, LCADC

NPI Number: 1710629258
Health Care Provider/Practitioner: LISA MARIE MUNN MS, LCADC

Information about “1710629258” NPI (LISA MARIE MUNN MS, LCADC) exists in 1710629258 in HTML format HTML  |  1710629258 in plain Text format TXT  |  1710629258 in PDF (Portable Document Format) PDF  |  1710629258 in an XML format XML  formats.

NPI Number : 1710629258 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710629258",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MUNN",
    "FirstName": "LISA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS, LCADC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "924 SOMERSET ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLOUCESTER CITY",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08030-1857",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "609-320-3336",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "923 HADDONFIELD RD STE 308",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHERRY HILL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08002-2752",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-324-8308",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/13/2022",
    "LastUpdateDate": "04/13/2022",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "37LC00238000",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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