{
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"FirstLineMailingAddress": "555 BLOOMING GROVE TPKE",
"SecondLineMailingAddress": "SUITE 101",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "555 BLOOMING GROVE TPKE",
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"PracticeLocationAddressFaxNumber": "845-565-0142",
"EnumerationDate": "08/17/2015",
"LastUpdateDate": "08/17/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "WALDO",
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"AuthorizedOfficialCredential": "CSW",
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"Taxonomies": {
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"TaxonomyName": "Clinical Social Worker",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}