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1790253581 NPI number — STEPHANIE PAGE BEITLICH LMSW

NPI Number: 1790253581
Health Care Provider/Practitioner: STEPHANIE PAGE BEITLICH LMSW

Information about “1790253581” NPI (STEPHANIE PAGE BEITLICH LMSW) exists in 1790253581 in HTML format HTML  |  1790253581 in plain Text format TXT  |  1790253581 in PDF (Portable Document Format) PDF  |  1790253581 in an XML format XML  formats.

NPI Number : 1790253581 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790253581",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEITLICH",
    "FirstName": "STEPHANIE",
    "MiddleName": "PAGE",
    "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": "540 OGLETHORPE AVE APT 504",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATHENS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30606-2225",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-709-6033",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "45 EAGLE OVERLOOK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAHLONEGA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30533-6665",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-867-0006",
    "PracticeLocationAddressFaxNumber": "706-864-0060",
    "EnumerationDate": "11/09/2018",
    "LastUpdateDate": "02/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "05/05/2020",
    "NPIReactivationDate": "02/24/2026",
    "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": "MSW007639",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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