{
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"EIN": null,
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"FirstLineMailingAddress": "111 TOWN SQUARE PL",
"SecondLineMailingAddress": "STE 1201, PMB 1023",
"MailingAddressCityName": "JERSEY CITY",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07310-1724",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-820-5674",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "111 TOWN SQUARE PL",
"SecondLinePracticeLocationAddress": "STE 1201, PMB 1023",
"PracticeLocationAddressCityName": "JERSEY CITY",
"PracticeLocationAddressStateName": "NJ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-820-5674",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/10/2019",
"LastUpdateDate": "12/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "001478",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}