{
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"FirstLineMailingAddress": "90 BRIARWOOD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLAINVIEW",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11803-6404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-458-3027",
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"FirstLinePracticeLocationAddress": "136 WOODBURY RD STE 101C",
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"PracticeLocationAddressCityName": "WOODBURY",
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"EnumerationDate": "03/07/2018",
"LastUpdateDate": "03/07/2018",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "IVRY",
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"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "516-458-3909",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Social Worker",
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"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}