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1851074447 NPI number — KIMBERLY D MCCRAY SLUSSER PEER SUPPORT SPECIAL

NPI Number: 1851074447
Health Care Provider/Practitioner: KIMBERLY D MCCRAY SLUSSER PEER SUPPORT SPECIAL

Information about “1851074447” NPI (KIMBERLY D MCCRAY SLUSSER PEER SUPPORT SPECIAL) exists in 1851074447 in HTML format HTML  |  1851074447 in plain Text format TXT  |  1851074447 in PDF (Portable Document Format) PDF  |  1851074447 in an XML format XML  formats.

NPI Number : 1851074447 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851074447",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCRAY SLUSSER",
    "FirstName": "KIMBERLY",
    "MiddleName": "D",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PEER SUPPORT SPECIAL",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCCLAY SLUSSER",
    "OtherFirstName": "KIMBERLY",
    "OtherMiddleName": "D",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PEER SUPPORT SPECIAL",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "16039 STATE ROUTE 30",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONSTABLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12926-2704",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-714-3195",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "125 FINNEY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MALONE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12953-1067",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-481-8160",
    "PracticeLocationAddressFaxNumber": "518-483-0878",
    "EnumerationDate": "08/09/2023",
    "LastUpdateDate": "08/09/2023",
    "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": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": "175T00000X",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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