{
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"IsOrgSubpart": "N",
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"OrgName": "BRIDGE COUNSELING CENTER INC",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 286",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SMITHTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11787-0286",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-360-6695",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "269 E MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE F2",
"PracticeLocationAddressCityName": "SMITHTOWN",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-360-6695",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/22/2006",
"LastUpdateDate": "07/20/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAIA",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "F",
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"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": "LCSW-R",
"AuthorizedOfficialTelephoneNumber": "631-360-6695",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "075024-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}