{
"Npi": {
"NPI": "1538357272",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DOORN",
"FirstName": "JEFFREY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "460 BLOOMFIELD AVE",
"SecondLineMailingAddress": "SUITE 305",
"MailingAddressCityName": "MONTCLAIR",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07042-3582",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-650-2815",
"MailingAddressFaxNumber": "201-438-7293",
"FirstLinePracticeLocationAddress": "460 BLOOMFIELD AVENUE",
"SecondLinePracticeLocationAddress": "SUITE 209",
"PracticeLocationAddressCityName": "MONTCLAIR",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07042",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-650-2815",
"PracticeLocationAddressFaxNumber": "201-438-7293",
"EnumerationDate": "10/09/2007",
"LastUpdateDate": "02/16/2022",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "44SC04552200",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}