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1881147015 NPI number — SVETLANA BRUK SKORNYAKOV M.S., MFT

NPI Number: 1881147015
Health Care Provider/Practitioner: SVETLANA BRUK SKORNYAKOV M.S., MFT

Information about “1881147015” NPI (SVETLANA BRUK SKORNYAKOV M.S., MFT) exists in 1881147015 in HTML format HTML  |  1881147015 in plain Text format TXT  |  1881147015 in PDF (Portable Document Format) PDF  |  1881147015 in an XML format XML  formats.

NPI Number : 1881147015 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881147015",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SKORNYAKOV",
    "FirstName": "SVETLANA",
    "MiddleName": "BRUK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., MFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6760 S FULTONDALE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AURORA",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80016-4133",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "650-455-5940",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2600 SOUTH PARKER RD",
    "SecondLinePracticeLocationAddress": "BUILDING 5 SUITE 155",
    "PracticeLocationAddressCityName": "AURORA",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80014",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "720-669-3962",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/23/2016",
    "LastUpdateDate": "02/20/2019",
    "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": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "LMFT93502",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "MFT0001557",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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