{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CARMEN M RIVERA, LCSW",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"FirstLineMailingAddress": "104 FULTON AVE",
"SecondLineMailingAddress": "CHILD MED GRP",
"MailingAddressCityName": "POUGHKEEPSIE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12603-2808",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-981-0912",
"MailingAddressFaxNumber": "845-765-2489",
"FirstLinePracticeLocationAddress": "104 FULTON AVE",
"SecondLinePracticeLocationAddress": "CHILD MED GRP",
"PracticeLocationAddressCityName": "POUGHKEEPSIE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12603-2808",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-981-0912",
"PracticeLocationAddressFaxNumber": "845-765-2489",
"EnumerationDate": "11/19/2010",
"LastUpdateDate": "06/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RIVERA",
"AuthorizedOfficialFirstName": "CARMEN",
"AuthorizedOfficialMiddleName": "MILAGROS",
"AuthorizedOfficialTitle": "PROPRIETOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW, LCSW",
"AuthorizedOfficialTelephoneNumber": "302-981-0912",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "078405",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}