{
"Npi": {
"NPI": "1730851395",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "CLINTON HUMAN SERVICES",
"ParentOrgTIN": null,
"OrgName": "CLINTON HUMAN SERVICES LPC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "48 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLINTON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06413-2035",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-664-1158",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "48 E MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLINTON",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06413-2035",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-664-1158",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/01/2021",
"LastUpdateDate": "05/24/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAGLINO",
"AuthorizedOfficialFirstName": "JILL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CLINICIAN",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "860-664-1155",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}