{
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"FirstLineMailingAddress": "25 W RAYEN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YOUNGSTOWN",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44503-1000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-746-6361",
"MailingAddressFaxNumber": "330-747-6360",
"FirstLinePracticeLocationAddress": "25 W. RAYEN AVE",
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"PracticeLocationAddressCityName": "YOUNGSTOWN",
"PracticeLocationAddressStateName": "OH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-746-6361",
"PracticeLocationAddressFaxNumber": "330-747-6360",
"EnumerationDate": "06/13/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Social Worker",
"LicenseNumber": "S.0016997",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}