{
"Npi": {
"NPI": "1578764981",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PETTIFORD",
"FirstName": "LORETTA",
"MiddleName": "CLARISE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MSW,LICSW,LCSW-C,C.P",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LANE",
"OtherFirstName": "LORETTA",
"OtherMiddleName": "CLARISE",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "12611 HENRY DR SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAVALE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21502-6147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-727-2451",
"MailingAddressFaxNumber": "301-777-1951",
"FirstLinePracticeLocationAddress": "12611 HENRY DR SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAVALE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21502-6147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-727-2451",
"PracticeLocationAddressFaxNumber": "301-777-1951",
"EnumerationDate": "05/31/2007",
"LastUpdateDate": "02/01/2019",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "13717",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}