{
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"OrgName": "WAYNE M. GURNICK MS, LCSW P.C.",
"LastName": null,
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"FirstLineMailingAddress": "2 ELLEN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANORVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11949-3222",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "111 MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CENTER MORICHES",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "631-603-7902",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2013",
"LastUpdateDate": "01/23/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GURNICK",
"AuthorizedOfficialFirstName": "WAYNE",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "LICENSED CLINICAL SOCIAL WORKER",
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"AuthorizedOfficialCredential": "MS, LCSW",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "R050891",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}