{
"Npi": {
"NPI": "1124110929",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BAXTER",
"FirstName": "CAROL",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "M.S.W.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BAXTER-PULICE",
"OtherFirstName": "CAROL",
"OtherMiddleName": null,
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "M.S.W.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "416 PEQUOT AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHPORT",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06890",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-209-4136",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2228 BLACK ROCK TURNPIKE",
"SecondLinePracticeLocationAddress": "SUITE 311",
"PracticeLocationAddressCityName": "FAIRFIELD",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06825",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-366-2552",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/29/2006",
"LastUpdateDate": "12/04/2008",
"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": "CT 000750",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}