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1811939390 NPI number — DEBRA E BURDICK LCSW, BCN

NPI Number: 1811939390
Health Care Provider/Practitioner: DEBRA E BURDICK LCSW, BCN

Information about “1811939390” NPI (DEBRA E BURDICK LCSW, BCN) exists in 1811939390 in HTML format HTML  |  1811939390 in plain Text format TXT  |  1811939390 in PDF (Portable Document Format) PDF  |  1811939390 in an XML format XML  formats.

NPI Number : 1811939390 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811939390",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURDICK",
    "FirstName": "DEBRA",
    "MiddleName": "E",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW, BCN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3 CONTINENTAL LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WASHINGTONVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10992-1332",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-496-9637",
    "MailingAddressFaxNumber": "866-872-1759",
    "FirstLinePracticeLocationAddress": "310 RIVER ROAD EXT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW PALTZ",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12561-3080",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "845-658-8083",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/11/2006",
    "LastUpdateDate": "01/20/2012",
    "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": "078801R",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "003903",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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