{
"Npi": {
"NPI": "1356706162",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LATRINA SMITH & ASSOCIATES",
"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": "605 PICCADILLY LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOLINGBROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60440-1021",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-253-6518",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "682 W BOUGHTON RD",
"SecondLinePracticeLocationAddress": "UNIT D",
"PracticeLocationAddressCityName": "BOLINGBROOK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60440-5700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "331-333-9074",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/21/2015",
"LastUpdateDate": "06/20/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "LATRINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSE CLINICAL SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW",
"AuthorizedOfficialTelephoneNumber": "630-253-6518",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "149017198",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}