{
"Npi": {
"NPI": "1861721243",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JASON M. GOLDBERG, LCSW-C",
"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": "4401 E WEST HWY",
"SecondLineMailingAddress": "SUITE 207",
"MailingAddressCityName": "BETHESDA",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20814-4523",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-329-7696",
"MailingAddressFaxNumber": "301-907-3342",
"FirstLinePracticeLocationAddress": "4401 E WEST HWY",
"SecondLinePracticeLocationAddress": "SUITE 207",
"PracticeLocationAddressCityName": "BETHESDA",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20814-4523",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-329-7696",
"PracticeLocationAddressFaxNumber": "301-907-3342",
"EnumerationDate": "12/15/2009",
"LastUpdateDate": "12/15/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDBERG",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": "MATTHEW",
"AuthorizedOfficialTitle": "OWNER OF PSYCHOTHERAPY PRACTICE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW-C",
"AuthorizedOfficialTelephoneNumber": "202-329-7696",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "12697",
"LicenseNumberStateCode": "MD",
"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."
}
}
}
}