{
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"FirstLineMailingAddress": "3533 98TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11368-1860",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7050 AUSTIN ST",
"SecondLinePracticeLocationAddress": "113 LOWER LEVEL",
"PracticeLocationAddressCityName": "FOREST HILLS",
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"EnumerationDate": "03/17/2015",
"LastUpdateDate": "03/17/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARCIA",
"AuthorizedOfficialFirstName": "LESLIE",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Social Worker",
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"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}