{
"Npi": {
"NPI": "1952732026",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DORVIL",
"FirstName": "CLEDICIANNE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DORVIL",
"OtherFirstName": "CLEDICIANNE",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSY.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "120 ROBERTSON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORRISVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19067-2447",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "609-532-0005",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "904 RIVERSIDE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TRENTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08618-5318",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-393-1166",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/27/2013",
"LastUpdateDate": "02/08/2014",
"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": "103TS0200X",
"TaxonomyName": "School Psychologist",
"LicenseNumber": "692206",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC2200X",
"TaxonomyName": "Clinical Child & Adolescent Psychologist",
"LicenseNumber": "PS017367",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103TC2200X",
"TaxonomyName": "Clinical Child & Adolescent Psychologist",
"LicenseNumber": "35SI00522100",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}