{
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"OrgName": "ANDEE CANTAVERO, LCSW",
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"FirstLineMailingAddress": "116 INDIAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT CHESTER",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10573-2245",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-912-8195",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2001 W MAIN ST STE 106C",
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"PracticeLocationAddressCityName": "STAMFORD",
"PracticeLocationAddressStateName": "CT",
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"EnumerationDate": "02/23/2007",
"LastUpdateDate": "07/18/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CANTAVERO",
"AuthorizedOfficialFirstName": "ANDEE",
"AuthorizedOfficialMiddleName": "KRISTEN",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "005379",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}