{
"Npi": {
"NPI": "1568712065",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DZIERZEWSKI",
"FirstName": "ROXANNE",
"MiddleName": "BAYAN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BAYAN",
"OtherFirstName": "ROXANNE",
"OtherMiddleName": "NONA",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSYD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1901 HUGUENOT RD STE 305",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH CHESTERFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23235-4311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-859-1966",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1901 HUGUENOT RD STE 305",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH CHESTERFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23235",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-859-1966",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/12/2012",
"LastUpdateDate": "06/05/2018",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "0810005033",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}