{
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"FirstLineMailingAddress": "1146 MASON DR",
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"MailingAddressCityName": "PACIFICA",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-761-1956",
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"FirstLinePracticeLocationAddress": "1303 SAN CARLOS AVE",
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"PracticeLocationAddressCityName": "SAN CARLOS",
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"EnumerationDate": "06/13/2025",
"LastUpdateDate": "06/13/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLATTERY",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "STEVEN",
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialTelephoneNumber": "650-761-1956",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}