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1912794900 NPI number — DR. MATT DILL

NPI Number: 1912794900
Health Care Provider/Practitioner: DR. MATT DILL

Information about “1912794900” NPI (DR. MATT DILL) exists in 1912794900 in HTML format HTML  |  1912794900 in plain Text format TXT  |  1912794900 in PDF (Portable Document Format) PDF  |  1912794900 in an XML format XML  formats.

NPI Number : 1912794900 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912794900",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DILL",
    "FirstName": "MATT",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "76 HYDE PARK AVE APT 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JAMAICA PLAIN",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02130-4393",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1581 BEACON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BROOKLINE",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02446-4602",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "617-870-3958",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/22/2025",
    "LastUpdateDate": "04/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "102L00000X",
          "TaxonomyName": "Psychoanalyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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