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1760342950 NPI number — BREA O SAMUEL CLARKE LMSW

NPI Number: 1760342950
Health Care Provider/Practitioner: BREA O SAMUEL CLARKE LMSW

Information about “1760342950” NPI (BREA O SAMUEL CLARKE LMSW) exists in 1760342950 in HTML format HTML  |  1760342950 in plain Text format TXT  |  1760342950 in PDF (Portable Document Format) PDF  |  1760342950 in an XML format XML  formats.

NPI Number : 1760342950 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760342950",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SAMUEL CLARKE",
    "FirstName": "BREA",
    "MiddleName": "O",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "42 HUNTER BROOK LN # E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "QUEENSBURY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12804-5858",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "929-771-4210",
    "MailingAddressFaxNumber": "929-771-4210",
    "FirstLinePracticeLocationAddress": "326 STATE ROUTE 28N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH CREEK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12853-3903",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-791-2966",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/12/2025",
    "LastUpdateDate": "11/12/2025",
    "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": "129463",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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