{
"Npi": {
"NPI": "1386725323",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MAIDEN",
"FirstName": "ROBERT",
"MiddleName": "JOSEPH",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12 MARTIN ST, SUITE 3",
"SecondLineMailingAddress": "SUITE 3",
"MailingAddressCityName": "WELLSVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "585-593-9815",
"MailingAddressFaxNumber": "585-596-4048",
"FirstLinePracticeLocationAddress": "12 MARTIN ST",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "WELLSVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14895",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "585-593-1859",
"PracticeLocationAddressFaxNumber": "585-593-2465",
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "10/01/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "006688-2",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "006688",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}