{
"Npi": {
"NPI": "1578276655",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HODGE",
"FirstName": "ANDREW",
"MiddleName": "JOSEPH",
"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": "153 PORTLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLD ORCHARD BEACH",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04064-1521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-289-8401",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "314 ALFRED ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BIDDEFORD",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04005-3102",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-370-5389",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/03/2023",
"LastUpdateDate": "01/03/2023",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "MC20937",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}