{
"Npi": {
"NPI": "1124091046",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOELSSON",
"FirstName": "MIA",
"MiddleName": "RENEE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PETERITAS",
"OtherFirstName": "MIA",
"OtherMiddleName": "RENEE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LCSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "205 RIDGEPOINT PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GAITHERSBURG",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20878-5703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "484-432-3213",
"MailingAddressFaxNumber": "866-613-8972",
"FirstLinePracticeLocationAddress": "849 QUINCE ORCHARD BLVD STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GAITHERSBURG",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20878-1604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-454-3002",
"PracticeLocationAddressFaxNumber": "866-613-8972",
"EnumerationDate": "02/10/2006",
"LastUpdateDate": "05/07/2012",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CW014749",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "17853",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}