{
"Npi": {
"NPI": "1245698372",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BONFIGLI",
"FirstName": "HEIDI",
"MiddleName": "CRYSTAL",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "M.S., M.A. LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LAGE",
"OtherFirstName": "HEIDI",
"OtherMiddleName": "CRYSTAL",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "766 W NAPA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SONOMA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95476-6452",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-246-4961",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "766 W NAPA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SONOMA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95476-6452",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "415-246-4961",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/03/2016",
"LastUpdateDate": "02/06/2021",
"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": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "117296",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}