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1942049887 NPI number — NICOLE VENTURA ROACH MA, LPC, RDT

NPI Number: 1942049887
Health Care Provider/Practitioner: NICOLE VENTURA ROACH MA, LPC, RDT

Information about “1942049887” NPI (NICOLE VENTURA ROACH MA, LPC, RDT) exists in 1942049887 in HTML format HTML  |  1942049887 in plain Text format TXT  |  1942049887 in PDF (Portable Document Format) PDF  |  1942049887 in an XML format XML  formats.

NPI Number : 1942049887 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942049887",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VENTURA ROACH",
    "FirstName": "NICOLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, LPC, RDT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1 BIRCH DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WALLINGFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06492-5210",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-669-0057",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "85 WILLOW ST STE 7",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW HAVEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06511-2696",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-871-1876",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/21/2024",
    "LastUpdateDate": "05/21/2024",
    "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": "101200000X",
          "TaxonomyName": "Drama Therapist",
          "LicenseNumber": "834",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "6384",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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