{
"Npi": {
"NPI": "1336719368",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "R.E.A.L. THERAPY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "566 BELLEVUE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TRENTON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08618-4402",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "609-963-5051",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 CAMPUS TOWN CIR STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EWING",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08638-1962",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-552-7325",
"PracticeLocationAddressFaxNumber": "609-594-1200",
"EnumerationDate": "06/30/2021",
"LastUpdateDate": "06/30/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAVAGE",
"AuthorizedOfficialFirstName": "TIANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "609-963-5051",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}