{
"Npi": {
"NPI": "1518303718",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIAMI BRIDGE YOUTH & FAMILY SERVICES, INC.",
"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": "2810 NW SOUTH RIVER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33125-1120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-635-8953",
"MailingAddressFaxNumber": "305-636-3521",
"FirstLinePracticeLocationAddress": "2810 NW SOUTH RIVER DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIAMI",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33125-1120",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-635-8953",
"PracticeLocationAddressFaxNumber": "305-636-3521",
"EnumerationDate": "05/14/2013",
"LastUpdateDate": "05/14/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDREWS",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S., CRC",
"AuthorizedOfficialTelephoneNumber": "305-636-3520",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "100023337",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}