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1750409041 NPI number — ELIZABETH WALLACH MA

NPI Number: 1750409041
Health Care Provider/Practitioner: ELIZABETH WALLACH MA

Information about “1750409041” NPI (ELIZABETH WALLACH MA) exists in 1750409041 in HTML format HTML  |  1750409041 in plain Text format TXT  |  1750409041 in PDF (Portable Document Format) PDF  |  1750409041 in an XML format XML  formats.

NPI Number : 1750409041 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750409041",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLACH",
    "FirstName": "ELIZABETH",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAILY WALLACH",
    "OtherFirstName": "ELIZABETH",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1061 WATERDAM PLAZA DR STE 208",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CANONSBURG",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15317-5408",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "724-413-4991",
    "MailingAddressFaxNumber": "724-260-0221",
    "FirstLinePracticeLocationAddress": "1061 WATERDAM PLAZA DR STE 208",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CANONSBURG",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "15317-5408",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "724-413-4991",
    "PracticeLocationAddressFaxNumber": "724-260-0221",
    "EnumerationDate": "03/26/2007",
    "LastUpdateDate": "02/10/2023",
    "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": "103T00000X",
        "TaxonomyName": "Psychologist",
        "LicenseNumber": "PS6340L",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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