{
"Npi": {
"NPI": "1083377915",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MENA",
"FirstName": "GEORGINA",
"MiddleName": "R",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MENA ROSAS",
"OtherFirstName": "GEORGINA",
"OtherMiddleName": "R",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "ROSAS",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1108 CRANBROOK WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASHEBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27205-2334",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-523-4910",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "111 POMONA DR STE G",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27407-1636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-855-0009",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/18/2021",
"LastUpdateDate": "10/18/2021",
"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": "106S00000X",
"TaxonomyName": "Behavior Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}