{
"Npi": {
"NPI": "1750107546",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SMALL FOOTSTEPS LICENSED BEHAVIOR ANALYSIS PC",
"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": "181 PINE TREE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONROE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10950-3967",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-296-9221",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "181 PINE TREE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONROE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10950-3967",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-296-9221",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/26/2024",
"LastUpdateDate": "07/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAVERAS",
"AuthorizedOfficialFirstName": "WIDNA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSED BEHAVIOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "646-296-9221",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251T00000X",
"TaxonomyName": "PACE Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}