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1932755964 NPI number — ANDREA MACKAY GODINEZ LCSW

NPI Number: 1932755964
Health Care Provider/Practitioner: ANDREA MACKAY GODINEZ LCSW

Information about “1932755964” NPI (ANDREA MACKAY GODINEZ LCSW) exists in 1932755964 in HTML format HTML  |  1932755964 in plain Text format TXT  |  1932755964 in PDF (Portable Document Format) PDF  |  1932755964 in an XML format XML  formats.

NPI Number : 1932755964 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932755964",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GODINEZ",
    "FirstName": "ANDREA",
    "MiddleName": "MACKAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MACKAY",
    "OtherFirstName": "ANDREA",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3020 CHILDREN'S WAY MC5100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92123",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-966-1700",
    "MailingAddressFaxNumber": "858-966-8055",
    "FirstLinePracticeLocationAddress": "3020 CHILDREN'S WAY MC5100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92123",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "858-966-1700",
    "PracticeLocationAddressFaxNumber": "858-966-8055",
    "EnumerationDate": "08/15/2019",
    "LastUpdateDate": "08/15/2019",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "LCSW19309",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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