{
"Npi": {
"NPI": "1487026183",
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "ACTSINC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "151 NEW PARK AVE",
"SecondLineMailingAddress": "SUITE 120",
"MailingAddressCityName": "HARTFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06106-2170",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-652-2100",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "151 NEW PARK AVE",
"SecondLinePracticeLocationAddress": "SUITE 120",
"PracticeLocationAddressCityName": "HARTFORD",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06106-2170",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-652-2100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/21/2015",
"LastUpdateDate": "11/09/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALEZ",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CLINICIAN",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "LADC",
"AuthorizedOfficialTelephoneNumber": "516-652-2100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "1090",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}