{
"Npi": {
"NPI": "1750588778",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SUZUKI",
"FirstName": "SANDRA",
"MiddleName": "BROSE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LCPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BROSE",
"OtherFirstName": "SANDRA",
"OtherMiddleName": "CAROL",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "LCPC, MHC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "16184 EDGEMONT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT MYERS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33908-3652",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-284-0636",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "22904 LYDEN DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ESTERO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33928-7047",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-494-3951",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/02/2007",
"LastUpdateDate": "11/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "180005930",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "24188",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}