1902865397 NPI number — JENNIFER WARREN GREAVES L.C.S.W., L.A.D.C.

NPI Number: 1902865397
Health Care Provider/Practitioner: JENNIFER WARREN GREAVES L.C.S.W., L.A.D.C.

NPI Number : 1902865397 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902865397",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GREAVES",
    "FirstName": "JENNIFER",
    "MiddleName": "WARREN",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "L.C.S.W., L.A.D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FOWLER-GREAVES",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "WARREN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "L.C.S.W., L.A.D.C.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "95 PARKER ST",
    "SecondLineMailingAddress": "STE 5",
    "MailingAddressCityName": "NEWBURYPORT",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01950-4034",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-773-3300",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "106 SKYLARK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04103-2082",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-831-2580",
    "PracticeLocationAddressFaxNumber": "207-221-2957",
    "EnumerationDate": "03/22/2006",
    "LastUpdateDate": "06/25/2019",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LC1990",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LC2965",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}