{
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"FirstLineMailingAddress": "PO BOX 453 BRISTOL, CT 06011",
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"MailingAddressStateName": "CT",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "203-879-4442",
"FirstLinePracticeLocationAddress": "246 WOLCOTT RD.",
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"PracticeLocationAddressCityName": "WOLCOTT",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressFaxNumber": "203-879-4442",
"EnumerationDate": "06/04/2010",
"LastUpdateDate": "06/17/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUNTZ",
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"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "860-977-7260",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}