{
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"FirstLineMailingAddress": "34 W LYNBROOK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLLINGDALE",
"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "225 S 69TH ST",
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"PracticeLocationAddressCityName": "UPPER DARBY",
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"PracticeLocationAddressTelephoneNumber": "610-352-8943",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/02/2018",
"LastUpdateDate": "01/02/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Social Worker",
"LicenseNumber": "SW134635",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}