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1790356426 NPI number — MICHELLE LEIGH SHIPPOS LCSW

NPI Number: 1790356426
Health Care Provider/Practitioner: MICHELLE LEIGH SHIPPOS LCSW

Information about “1790356426” NPI (MICHELLE LEIGH SHIPPOS LCSW) exists in 1790356426 in HTML format HTML  |  1790356426 in plain Text format TXT  |  1790356426 in PDF (Portable Document Format) PDF  |  1790356426 in an XML format XML  formats.

NPI Number : 1790356426 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790356426",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIPPOS",
    "FirstName": "MICHELLE",
    "MiddleName": "LEIGH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SCOTT",
    "OtherFirstName": "MICHELLE",
    "OtherMiddleName": "LEIGH",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "208 N MEADOW ST UNIT 3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ITHACA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14850-4027",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "607-862-6252",
    "MailingAddressFaxNumber": "844-333-0375",
    "FirstLinePracticeLocationAddress": "208 N MEADOW ST UNIT 3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ITHACA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14850-4027",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "607-862-6252",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/04/2021",
    "LastUpdateDate": "04/26/2022",
    "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": "088525",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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