{
"Npi": {
"NPI": "1639465123",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PELLETIER",
"FirstName": "NICOLE",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "LICSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 273331",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT COLLINS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80527-3331",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-714-4459",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "155 W HARVARD ST",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "FORT COLLINS",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80525-5200",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-266-8644",
"PracticeLocationAddressFaxNumber": "970-267-8645",
"EnumerationDate": "06/22/2011",
"LastUpdateDate": "01/12/2016",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "116969",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CSW.09923836",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}