{
"Npi": {
"NPI": "1922217959",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MILDEBERGER",
"FirstName": "LISA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MS, CRC, LMHC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MILDEBERGER",
"OtherFirstName": "LISA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MS, CRC, LMHC",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "61 CEDAR ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MASSAPEQUA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11758-5726",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-804-6232",
"MailingAddressFaxNumber": "516-804-6232",
"FirstLinePracticeLocationAddress": "3375 PARK AVE.",
"SecondLinePracticeLocationAddress": "SUITE 3008",
"PracticeLocationAddressCityName": "WANTAGH",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11793",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-986-3847",
"PracticeLocationAddressFaxNumber": "516-804-6232",
"EnumerationDate": "05/22/2007",
"LastUpdateDate": "05/02/2014",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "001776",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}