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1902164304 NPI number — GLORIA ESTHER FONTES LCSW

NPI Number: 1902164304
Health Care Provider/Practitioner: GLORIA ESTHER FONTES LCSW

Information about “1902164304” NPI (GLORIA ESTHER FONTES LCSW) exists in 1902164304 in HTML format HTML  |  1902164304 in plain Text format TXT  |  1902164304 in PDF (Portable Document Format) PDF  |  1902164304 in an XML format XML  formats.

NPI Number : 1902164304 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902164304",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FONTES",
    "FirstName": "GLORIA",
    "MiddleName": "ESTHER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BAEZA",
    "OtherFirstName": "GLORIA",
    "OtherMiddleName": "ESTHER",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ASW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "800 SCENIC DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MODESTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95350-6131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-525-5157",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "29101 HOSPITAL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE ARROWHEAD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92352-9706",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-436-3235",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/24/2012",
    "LastUpdateDate": "01/26/2024",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "LCSW81836",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "ASW 30541",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW81836",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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