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1750438412 NPI number — KENYA WILDER LCSW

NPI Number: 1750438412
Health Care Provider/Practitioner: KENYA WILDER LCSW

Information about “1750438412” NPI (KENYA WILDER LCSW) exists in 1750438412 in HTML format HTML  |  1750438412 in plain Text format TXT  |  1750438412 in PDF (Portable Document Format) PDF  |  1750438412 in an XML format XML  formats.

NPI Number : 1750438412 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750438412",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILDER",
    "FirstName": "KENYA",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "38 ARCHER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST HEMPSTEAD",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11552-1730",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-849-9904",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "38 ARCHER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST HEMPSTEAD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11552-1730",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "91-784-9990",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/04/2007",
    "LastUpdateDate": "04/21/2023",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "069540",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "064445-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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