{
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"OrgName": "BREAK FREE CENTER FOR WELLNESS",
"LastName": null,
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"FirstLineMailingAddress": "130 VERNON AVE",
"SecondLineMailingAddress": "APARTMENT 2H",
"MailingAddressCityName": "VERNON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06066-3656",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-881-3076",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "642 HILLIARD ST",
"SecondLinePracticeLocationAddress": "SUITE 1223",
"PracticeLocationAddressCityName": "MANCHESTER",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06042-2700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-327-5790",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2017",
"LastUpdateDate": "03/07/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RILEY-SEYMOUR",
"AuthorizedOfficialFirstName": "SHARRON",
"AuthorizedOfficialMiddleName": "YVETTE",
"AuthorizedOfficialTitle": "OWNER/COUNSELOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "860-881-3076",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "002815",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}