{
"Npi": {
"NPI": "1093942518",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GERRITSEN",
"FirstName": "JACQUELINE",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MA, MFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1000 PARK PL APT P",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN MATEO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94403-7112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-315-7207",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2875 MIDDLEFIELD RD STE 8",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALO ALTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94306-2548",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-315-7207",
"PracticeLocationAddressFaxNumber": "540-323-2217",
"EnumerationDate": "06/11/2009",
"LastUpdateDate": "09/24/2019",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC44948",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}