{
"Npi": {
"NPI": "1235480484",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FERMIN",
"FirstName": "YESENIA",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MSW, LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BEUTEL",
"OtherFirstName": "YESENIA",
"OtherMiddleName": "R",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "MSW, LCSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "P.O. BOX 2562",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTFIELD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07091",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "908-652-7061",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "525 BOULEVARD SUITE 2",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "KENILWORTH",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07033",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "908-652-7061",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/27/2012",
"LastUpdateDate": "06/20/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"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": "44SC05517500",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "NJ44SC05S17500",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}