1982418752 NPI number — FERNANDEZ THERAPY GROUP LICENSED CLINICAL SOCIAL WORKER, CORP

NPI Number: 1982418752
Health Care Provider/Practitioner: FERNANDEZ THERAPY GROUP LICENSED CLINICAL SOCIAL WORKER, CORP

NPI Number : 1982418752 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982418752",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FERNANDEZ THERAPY GROUP LICENSED CLINICAL SOCIAL WORKER, CORP",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10810 PARAMOUNT BLVD STE 202",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOWNEY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90241-3351",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-248-3513",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10810 PARAMOUNT BLVD STE 202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOWNEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90241-3351",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-248-3513",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/03/2025",
    "LastUpdateDate": "02/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FERNANDEZ",
    "AuthorizedOfficialFirstName": "RONNIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "323-793-3595",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0855X",
          "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}