{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "748 JARVIS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHESHIRE",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06410-1522",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-623-6487",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2475 ALBANY AVE STE 205",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST HARTFORD",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/04/2020",
"LastUpdateDate": "11/04/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUCARELLI",
"AuthorizedOfficialFirstName": "LEAH",
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"AuthorizedOfficialTitle": "OWNER/PROVIDER",
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"AuthorizedOfficialCredential": "DNP, APRN, FNP-C",
"AuthorizedOfficialTelephoneNumber": "203-623-6487",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Primary Care Clinic/Center",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}