{
"Npi": {
"NPI": "1346521424",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHILDREN'S EDUCATIONAL & PSYCHOLOGICAL SERVICES",
"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": "2883 EXECUTIVE PARK DR",
"SecondLineMailingAddress": "SUITE 103 F",
"MailingAddressCityName": "WESTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33331-3662",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-579-6949",
"MailingAddressFaxNumber": "754-223-7123",
"FirstLinePracticeLocationAddress": "2883 EXECUTIVE PARK DR",
"SecondLinePracticeLocationAddress": "SUITE 103 F",
"PracticeLocationAddressCityName": "WESTON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33331-3662",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-579-6949",
"PracticeLocationAddressFaxNumber": "754-223-7123",
"EnumerationDate": "09/02/2011",
"LastUpdateDate": "09/02/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KRASKY",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LEAD PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.S.",
"AuthorizedOfficialTelephoneNumber": "954-579-6949",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "SS 989",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC1900X",
"TaxonomyName": "Counseling Psychologist",
"LicenseNumber": "SS 989",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}