{
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"OrgName": "NORTHEAST BEHAVIORAL HEALTH",
"LastName": null,
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"FirstLineMailingAddress": "41 MASON ST.",
"SecondLineMailingAddress": "4",
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"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01970",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-834-0324",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "41 MASON ST",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2013",
"LastUpdateDate": "04/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREIDEL",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "IRENE",
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"AuthorizedOfficialCredential": "L.C.S.W.",
"AuthorizedOfficialTelephoneNumber": "734-834-0324",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
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"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}