{
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"EIN": null,
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"FirstLineMailingAddress": "15 FALLS BASHAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOODUS",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-314-9078",
"MailingAddressFaxNumber": "203-579-3693",
"FirstLinePracticeLocationAddress": "2514 BOSTON POST RD",
"SecondLinePracticeLocationAddress": "SUITE 8 C",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-314-9078",
"PracticeLocationAddressFaxNumber": "209-579-3693",
"EnumerationDate": "06/07/2007",
"LastUpdateDate": "12/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "001043",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}