{
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"IsOrgSubpart": "N",
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"OrgName": "REENVISION MARRIAGE AND FAMILY THERAPY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "4003 164TH ST UNIT 580161",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLUSHING",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11358-2686",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3328 164TH ST FL 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11358-1442",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-354-6738",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/18/2022",
"LastUpdateDate": "01/18/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": "SENA",
"AuthorizedOfficialTitle": "OWNER/FOUNDER/THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A., LMFT",
"AuthorizedOfficialTelephoneNumber": "718-354-6738",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}