{
"Npi": {
"NPI": "1780367979",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VELLOZZI",
"FirstName": "SAMANTHA",
"MiddleName": "LOUISE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LAURO",
"OtherFirstName": "SAMANTHA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LMFT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "28649 S WESTERN AVE UNIT 6597",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN PEDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90734-0110",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-308-9980",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6850 E MAYO BLVD UNIT 2423",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85054-5693",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-308-9980",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/14/2023",
"LastUpdateDate": "11/08/2024",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "135962",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "16117",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}