{
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"IsOrgSubpart": "N",
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"OrgName": "ACACIA PSYCHIATRIC SERVICES PC",
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "29 WEST 36TH STREET",
"SecondLineMailingAddress": "APT 5B",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10018",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-584-7109",
"MailingAddressFaxNumber": "914-462-3599",
"FirstLinePracticeLocationAddress": "250 W 24TH ST",
"SecondLinePracticeLocationAddress": "APT 5BW",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10011-1703",
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"PracticeLocationAddressTelephoneNumber": "646-584-7109",
"PracticeLocationAddressFaxNumber": "914-462-3599",
"EnumerationDate": "03/28/2016",
"LastUpdateDate": "03/15/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POPEO",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "646-584-7109",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Counselor",
"LicenseNumber": "224044",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}