{
"Npi": {
"NPI": "1811503121",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CARBONNEAU",
"FirstName": "MARY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CCC-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "BOOTHBY THERAPY SERVICES",
"SecondLineMailingAddress": "806 NORTH MAIN STREET",
"MailingAddressCityName": "LACONIA",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03246",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-524-9090",
"MailingAddressFaxNumber": "603-524-1497",
"FirstLinePracticeLocationAddress": "38 MCELWAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MERRIMACK",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03054-3663",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-424-6204",
"PracticeLocationAddressFaxNumber": "603-424-6230",
"EnumerationDate": "09/22/2020",
"LastUpdateDate": "09/22/2020",
"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": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "1901",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}