{
"Npi": {
"NPI": "1619480795",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BULLOCK",
"FirstName": "ANASTASIA",
"MiddleName": "JEAN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SOKOL",
"OtherFirstName": "ANASTASIA",
"OtherMiddleName": "JEAN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1 FEDERAL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMDEN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08103-1088",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-356-4924",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 COOPER PLZ",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAMDEN",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08103-1461",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-342-2000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/10/2017",
"LastUpdateDate": "10/09/2018",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "35SI00586700",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}