{
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"OrgName": "HEATHERMARIE SPORTELLI",
"LastName": null,
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"FirstLineMailingAddress": "529 SEVEN BRIDGE RD",
"SecondLineMailingAddress": "SUITE 207",
"MailingAddressCityName": "EAST STROUDSBURG",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18301-7937",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-730-1234",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "529 SEVEN BRIDGE RD",
"SecondLinePracticeLocationAddress": "SUITE 207",
"PracticeLocationAddressCityName": "EAST STROUDSBURG",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressTelephoneNumber": "570-730-1234",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/11/2015",
"LastUpdateDate": "06/18/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPORTELLI",
"AuthorizedOfficialFirstName": "HEATHER",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NCC, LPC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "PC008010",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}