{
"Npi": {
"NPI": "1174286231",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HOLT",
"FirstName": "BENJAMIN",
"MiddleName": "G",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LOSURDO-HOLT",
"OtherFirstName": "BENJAMIN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LMSW",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "12317 VILLAGE SQUARE TER APT 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH BETHESDA",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20852-1943",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-753-6809",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "319 W PATRICK ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21701-4855",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-360-4349",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/15/2021",
"LastUpdateDate": "10/15/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"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": "26432",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}