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1992592463 NPI number — ANJELICA JADE DAVEY MENDOLA LCSW

NPI Number: 1992592463
Health Care Provider/Practitioner: ANJELICA JADE DAVEY MENDOLA LCSW

Information about “1992592463” NPI (ANJELICA JADE DAVEY MENDOLA LCSW) exists in 1992592463 in HTML format HTML  |  1992592463 in plain Text format TXT  |  1992592463 in PDF (Portable Document Format) PDF  |  1992592463 in an XML format XML  formats.

NPI Number : 1992592463 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992592463",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MENDOLA",
    "FirstName": "ANJELICA",
    "MiddleName": "JADE DAVEY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "191 MOORES SCHOOL LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEXINGTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24450-5930",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-323-5649",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "241 GREENHOUSE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEXINGTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24450-3717",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-463-3141",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/21/2025",
    "LastUpdateDate": "04/21/2025",
    "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": "0904018292",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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