{
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"FirstLineMailingAddress": "PO BOX 222",
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"MailingAddressCityName": "MENDENHALL",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "610-388-2163",
"FirstLinePracticeLocationAddress": "455 OLD BALTIMORE PIKE",
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"PracticeLocationAddressCityName": "CHADDS FORD",
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"PracticeLocationAddressFaxNumber": "610-388-2163",
"EnumerationDate": "01/12/2007",
"LastUpdateDate": "08/22/2020",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAFFER",
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"Taxonomies": {
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"TaxonomyName": "Psychologist",
"LicenseNumber": "P-005890-L",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}