{
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"FirstLineMailingAddress": "1609 S CONGRESS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOYNTON BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33426-6543",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-742-9802",
"MailingAddressFaxNumber": "561-364-1492",
"FirstLinePracticeLocationAddress": "1609 S CONGRESS AVE",
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"PracticeLocationAddressCityName": "BOYNTON BEACH",
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"PracticeLocationAddressTelephoneNumber": "561-742-9802",
"PracticeLocationAddressFaxNumber": "561-364-1492",
"EnumerationDate": "05/21/2012",
"LastUpdateDate": "05/21/2012",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOOD",
"AuthorizedOfficialFirstName": "SHEILA",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "SW4654",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}