{
"Npi": {
"NPI": "1689072514",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LABRADOR",
"FirstName": "CAITLIN",
"MiddleName": "ROSE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BLOOM",
"OtherFirstName": "CAITLIN",
"OtherMiddleName": "ROSE",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "MSW, RCSWI",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1301 PLANTATION ISLAND DR S STE 201B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32080-3116",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-342-5965",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1301 PLANTATION ISLAND DR S STE 201B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32080-3116",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-342-5965",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/09/2014",
"LastUpdateDate": "09/29/2016",
"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": "SW13916",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}