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1780643072 NPI number — MARY B MOONEN MSW

NPI Number: 1780643072
Health Care Provider/Practitioner: MARY B MOONEN MSW

Information about “1780643072” NPI (MARY B MOONEN MSW) exists in 1780643072 in HTML format HTML  |  1780643072 in plain Text format TXT  |  1780643072 in PDF (Portable Document Format) PDF  |  1780643072 in an XML format XML  formats.

NPI Number : 1780643072 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780643072",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOONEN",
    "FirstName": "MARY",
    "MiddleName": "B",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KENIFIC",
    "OtherFirstName": "MARY",
    "OtherMiddleName": "B",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3653 CORTEZ ROAD WEST",
    "SecondLineMailingAddress": "SUITE 110A",
    "MailingAddressCityName": "BRADENTON",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34210",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-962-6784",
    "MailingAddressFaxNumber": "941-753-8471",
    "FirstLinePracticeLocationAddress": "3653 CORTEZ ROAD WEST",
    "SecondLinePracticeLocationAddress": "SUITE 110A",
    "PracticeLocationAddressCityName": "BRADENTON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34210",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "941-962-6784",
    "PracticeLocationAddressFaxNumber": "941-753-8471",
    "EnumerationDate": "03/23/2006",
    "LastUpdateDate": "10/11/2011",
    "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": "SW8791",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "3413",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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