1942492418 NPI number — MICHAEL LOUIS MIRANTE PH.D., L.C.S.W., MSW

NPI Number: 1942492418
Health Care Provider/Practitioner: MICHAEL LOUIS MIRANTE PH.D., L.C.S.W., MSW

NPI Number : 1942492418 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942492418",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MIRANTE",
    "FirstName": "MICHAEL",
    "MiddleName": "LOUIS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D., L.C.S.W., MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 2620",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELKHART",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46515-2620",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "574-293-2000",
    "MailingAddressFaxNumber": "574-293-2001",
    "FirstLinePracticeLocationAddress": "227 S MAIN ST STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELKHART",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46516-3185",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-293-2000",
    "PracticeLocationAddressFaxNumber": "574-293-2001",
    "EnumerationDate": "08/17/2007",
    "LastUpdateDate": "07/21/2019",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW2616",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "34005408A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}