{
"Npi": {
"NPI": "1104325695",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARY MITCHELL HADDAD PMHNP 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,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "960 GREEN CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORANGE",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06477-1736",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-952-7571",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "211 E 43RD ST RM 1305",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10017-4779",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-952-7571",
"PracticeLocationAddressFaxNumber": "212-642-5111",
"EnumerationDate": "02/09/2018",
"LastUpdateDate": "03/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITCHELL HADDAD",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PMHNP",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN, MSN, PMHNP",
"AuthorizedOfficialTelephoneNumber": "203-952-7571",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "F402319-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}