{
"Npi": {
"NPI": "1184858870",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PECK",
"FirstName": "MISCHA",
"MiddleName": "COHEN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MA, MSW, PHD, LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PECK",
"OtherFirstName": "MISCHA",
"OtherMiddleName": "COHEN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MICHAEL DAVID PECK",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2030 N DAYTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85006-2123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-570-2373",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "301 E BETHANY HOME RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85012-1263",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-570-2373",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/08/2009",
"LastUpdateDate": "07/14/2017",
"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": "LCSW-12742",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}