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1750650487 NPI number — JENNIFER MARIE SULLIVAN-BRUNAULT LICSW

NPI Number: 1750650487
Health Care Provider/Practitioner: JENNIFER MARIE SULLIVAN-BRUNAULT LICSW

Information about “1750650487” NPI (JENNIFER MARIE SULLIVAN-BRUNAULT LICSW) exists in 1750650487 in HTML format HTML  |  1750650487 in plain Text format TXT  |  1750650487 in PDF (Portable Document Format) PDF  |  1750650487 in an XML format XML  formats.

NPI Number : 1750650487 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750650487",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SULLIVAN-BRUNAULT",
    "FirstName": "JENNIFER",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SULLIVAN",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "LICSW",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "335 WALNUT ST. EXTENSION, SUITE 200",
    "SecondLineMailingAddress": "AGAWAM PROFESSIONAL CENTER",
    "MailingAddressCityName": "AGAWAM",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01001-1524",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "413-789-8955",
    "MailingAddressFaxNumber": "413-789-0557",
    "FirstLinePracticeLocationAddress": "335 WALNUT ST. EXTENSION, SUITE 200",
    "SecondLinePracticeLocationAddress": "AGAWAM PROFESSIONAL CENTER",
    "PracticeLocationAddressCityName": "AGAWAM",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01001-1524",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "413-789-8955",
    "PracticeLocationAddressFaxNumber": "413-789-0557",
    "EnumerationDate": "12/27/2011",
    "LastUpdateDate": "12/27/2011",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "113195",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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