{
"Npi": {
"NPI": "1053443168",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERRY",
"FirstName": "CAROLYN",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4733 HASKELL AVE",
"SecondLineMailingAddress": "#48",
"MailingAddressCityName": "ENCINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91436-1616",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-986-2123",
"MailingAddressFaxNumber": "818-986-2123",
"FirstLinePracticeLocationAddress": "6931 VAN NUYS BLVD",
"SecondLinePracticeLocationAddress": "2ND FLOOR",
"PracticeLocationAddressCityName": "VAN NUYS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91405-3937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-909-5870",
"PracticeLocationAddressFaxNumber": "818-909-9980",
"EnumerationDate": "03/12/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC28911",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}