{
"Npi": {
"NPI": "1538423876",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WINEBURG",
"FirstName": "LISA",
"MiddleName": "M",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LCSW-BACS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RUFFIN",
"OtherFirstName": "LISA",
"OtherMiddleName": "M",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "LCSW-BACS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2439 MANHATTAN BLVD STE 304",
"SecondLineMailingAddress": "SUITE 304",
"MailingAddressCityName": "HARVEY",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70058",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-333-6657",
"MailingAddressFaxNumber": "504-373-6193",
"FirstLinePracticeLocationAddress": "2439 MANHATTAN BLVD",
"SecondLinePracticeLocationAddress": "SUITE 304",
"PracticeLocationAddressCityName": "HARVEY",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70058",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "504-333-6657",
"PracticeLocationAddressFaxNumber": "504-373-6193",
"EnumerationDate": "07/02/2012",
"LastUpdateDate": "11/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"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": "9573",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}