{
"Npi": {
"NPI": "1285864918",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRENER",
"FirstName": "MADELINE",
"MiddleName": "ESTHER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WESH",
"OtherFirstName": "MADELINE",
"OtherMiddleName": "ESTHER BRENER",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2505 OLD QUARRY RD APT 1516",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92108-2766",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-267-9257",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5005 TEXAS ST",
"SecondLinePracticeLocationAddress": "SUITE 203",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92108-3721",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-692-0727",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2009",
"LastUpdateDate": "04/15/2025",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "PSY31736",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}