{
"Npi": {
"NPI": "1124410709",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLETTE BRUNELL LCSW-C,BCD,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,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5550 STERRETT PL",
"SecondLineMailingAddress": "SUITE 314",
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21044-2611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-730-6119",
"MailingAddressFaxNumber": "410-290-6550",
"FirstLinePracticeLocationAddress": "5550 STERRETT PL",
"SecondLinePracticeLocationAddress": "SUITE 314",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21044-2611",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-730-6119",
"PracticeLocationAddressFaxNumber": "410-290-6550",
"EnumerationDate": "02/19/2015",
"LastUpdateDate": "07/20/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRUNELL",
"AuthorizedOfficialFirstName": "COLETTE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW-C,BCD",
"AuthorizedOfficialTelephoneNumber": "410-730-6119",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": "05994",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}