{
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"FirstLineMailingAddress": "316 W 94TH ST",
"SecondLineMailingAddress": "APT 3B",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10025-6855",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-473-0138",
"MailingAddressFaxNumber": "646-473-0140",
"FirstLinePracticeLocationAddress": "316 W 94TH ST",
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"PracticeLocationAddressFaxNumber": "646-473-0140",
"EnumerationDate": "04/14/2011",
"LastUpdateDate": "04/21/2011",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "POELVOORDE",
"AuthorizedOfficialFirstName": "JOAN",
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"AuthorizedOfficialTitle": "SOCIAL WORKER",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "PR019774",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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}
}
}
}