{
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"FirstLineMailingAddress": "11 EL CERRITO AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN RAFAEL",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94901-1908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-364-1616",
"MailingAddressFaxNumber": "415-457-1879",
"FirstLinePracticeLocationAddress": "1865 UNION ST",
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"PracticeLocationAddressCityName": "SAN FRANCISCO",
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"EnumerationDate": "05/02/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUNT",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "EYBER",
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"AuthorizedOfficialCredential": "PHD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychologist",
"LicenseNumber": "PSY 11200",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}