{
"Npi": {
"NPI": "1679485940",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VICINANZO",
"FirstName": "COLETTE",
"MiddleName": "OLIVIA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "30 ALBIN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOW",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03304-3702",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-484-8497",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "76 FORT EDDY RD STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CONCORD",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03301-7415",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-484-8497",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/21/2026",
"LastUpdateDate": "09/21/2026",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "253",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}