{
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"FirstLineMailingAddress": "396 ROUTES 6 AND 209",
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"FirstLinePracticeLocationAddress": "396 ROUTE 6 AND 209 STE 3B",
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"PracticeLocationAddressFaxNumber": "570-296-4044",
"EnumerationDate": "09/06/2006",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMBOUSEK",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
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"TaxonomyName": "Clinical Social Worker",
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}
},
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}
}
}
}