{
"Npi": {
"NPI": "1326241670",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DAVIDOVICH",
"FirstName": "ROZALINA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DAVIDOVICH",
"OtherFirstName": "ROZ",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSYD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "102 PEMBROKE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MELVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11747-4309",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-770-4909",
"MailingAddressFaxNumber": "631-504-0277",
"FirstLinePracticeLocationAddress": "900 WALT WHITMAN RD STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MELVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11747-2215",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "917-770-4909",
"PracticeLocationAddressFaxNumber": "631-504-0277",
"EnumerationDate": "06/06/2007",
"LastUpdateDate": "08/17/2021",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "017159",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}