{
"Npi": {
"NPI": "1063754877",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENISE C. WALL, LCSW LLC",
"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": "PO BOX 514",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ODESSA",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19730-0514",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-376-5259",
"MailingAddressFaxNumber": "302-689-4474",
"FirstLinePracticeLocationAddress": "610 MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ODESSA",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19730-2012",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-376-5259",
"PracticeLocationAddressFaxNumber": "302-689-4474",
"EnumerationDate": "03/19/2013",
"LastUpdateDate": "03/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALL",
"AuthorizedOfficialFirstName": "DENISE",
"AuthorizedOfficialMiddleName": "CECILIA",
"AuthorizedOfficialTitle": "PSYCHO THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "302-376-5259",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "Q1-0000304",
"LicenseNumberStateCode": "DE",
"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."
}
}
}
}