{
"Npi": {
"NPI": "1174987119",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEAL PSYCHIATRIC SERVICES, INC",
"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": "1710 S AMPHLETT BLVD",
"SecondLineMailingAddress": "SUITE 301",
"MailingAddressCityName": "SAN MATEO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94402-2703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-273-4082",
"MailingAddressFaxNumber": "650-275-7559",
"FirstLinePracticeLocationAddress": "1710 S AMPHLETT BLVD",
"SecondLinePracticeLocationAddress": "SUITE 301",
"PracticeLocationAddressCityName": "SAN MATEO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94402-2703",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-273-4082",
"PracticeLocationAddressFaxNumber": "650-275-7559",
"EnumerationDate": "04/06/2016",
"LastUpdateDate": "06/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AMIN",
"AuthorizedOfficialFirstName": "FARZANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "C.E.O.",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "650-273-4082",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "A95033",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0804X",
"TaxonomyName": "Child & Adolescent Psychiatry Physician",
"LicenseNumber": "A95033",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}