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1760638498 NPI number — DYLAN S MARIAH RN, LMHC

NPI Number: 1760638498
Health Care Provider/Practitioner: DYLAN S MARIAH RN, LMHC

Information about “1760638498” NPI (DYLAN S MARIAH RN, LMHC) exists in 1760638498 in HTML format HTML  |  1760638498 in plain Text format TXT  |  1760638498 in PDF (Portable Document Format) PDF  |  1760638498 in an XML format XML  formats.

NPI Number : 1760638498 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760638498",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARIAH",
    "FirstName": "DYLAN",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN, LMHC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5 STARLIGHT CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRPORT",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14450-9330",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "585-200-4646",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20 OFFICE PARK WAY STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PITTSFORD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14534",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "585-200-4646",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/13/2008",
    "LastUpdateDate": "04/10/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/02/2014",
    "NPIReactivationDate": "12/28/2018",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "002604",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "543015-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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