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1780290247 NPI number — KRISTEN JALOVECKY LCSW

NPI Number: 1780290247
Health Care Provider/Practitioner: KRISTEN JALOVECKY LCSW

Information about “1780290247” NPI (KRISTEN JALOVECKY LCSW) exists in 1780290247 in HTML format HTML  |  1780290247 in plain Text format TXT  |  1780290247 in PDF (Portable Document Format) PDF  |  1780290247 in an XML format XML  formats.

NPI Number : 1780290247 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780290247",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JALOVECKY",
    "FirstName": "KRISTEN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3301 MIAMI ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KNOXVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37917-2720",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "813-570-0365",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "390 PONDELLA RD STE 9",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT MYERS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33903-4340",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-652-0260",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/21/2020",
    "LastUpdateDate": "02/04/2023",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW17526",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LSW7771",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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