{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LEPHOENIX HEALTH SERVICES, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1749",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WASHINGTON",
"MailingAddressStateName": "DC",
"MailingAddressPostalCode": "20013-1749",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-466-1640",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "650 PENNSYLVANIA AVE SE",
"SecondLinePracticeLocationAddress": "SUITE 480",
"PracticeLocationAddressCityName": "WASHINGTON",
"PracticeLocationAddressStateName": "DC",
"PracticeLocationAddressPostalCode": "20003-4318",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-466-1640",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/04/2008",
"LastUpdateDate": "09/04/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANFORTH",
"AuthorizedOfficialFirstName": "LAVERNE",
"AuthorizedOfficialMiddleName": "V.",
"AuthorizedOfficialTitle": "SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.I.C.S.W.",
"AuthorizedOfficialTelephoneNumber": "202-466-1640",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LC302687",
"LicenseNumberStateCode": "DC",
"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."
}
}
}
}