{
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"EIN": null,
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"OrgName": "L.J KLEIN LCSW PC",
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"FirstLineMailingAddress": "2234 77TH ST APT B1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST ELMHURST",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11370-1246",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3051 36TH ST FL 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ASTORIA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11103-4704",
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"PracticeLocationAddressTelephoneNumber": "718-223-0384",
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"EnumerationDate": "12/13/2016",
"LastUpdateDate": "12/16/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KLEIN",
"AuthorizedOfficialFirstName": "LEONARDO",
"AuthorizedOfficialMiddleName": "J",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "082686",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}