{
"Npi": {
"NPI": "1225132558",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "REBELLO",
"FirstName": "DAVID",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW CASAC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 BELMONT PLACE",
"SecondLineMailingAddress": "APT 3E",
"MailingAddressCityName": "STATEN ISLAND",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-442-1488",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "312 BEMENT AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATEN ISLAND",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10310",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-442-1488",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/08/2006",
"LastUpdateDate": "07/08/2007",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "R028867",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "SC00739",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "5203",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}