{
"Npi": {
"NPI": "1811825284",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EPIPHANY VENTURE PARTNERS",
"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": "233 COLUMBUS AVE APT 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW HAVEN",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06519-2230",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-753-3412",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "126 ROUTE 46 E APT 15B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LODI",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07644-3627",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "917-903-5131",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2026",
"LastUpdateDate": "05/13/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "JAMARIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.A.",
"AuthorizedOfficialTelephoneNumber": "917-903-5131",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "172A00000X",
"TaxonomyName": "Driver",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}