{
"Npi": {
"NPI": "1275359358",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PAIGE",
"FirstName": "SHAWN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PAIGE",
"OtherFirstName": "SHAWN",
"OtherMiddleName": "ANTHONY",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LPMFT",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "22822 141ST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAURELTON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11413-2907",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "929-410-7704",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "444 S SALINA ST UNIT 186",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SYRACUSE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13201-2108",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "929-269-8915",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/23/2024",
"LastUpdateDate": "11/23/2024",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "06-P132800-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}