{
"Npi": {
"NPI": "1962822346",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PANOZZO THERAPY, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2351",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORLAND PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60462-1030",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-846-2869",
"MailingAddressFaxNumber": "708-349-1464",
"FirstLinePracticeLocationAddress": "15915 S CRYSTAL CREEK DR",
"SecondLinePracticeLocationAddress": "UNIT E",
"PracticeLocationAddressCityName": "HOMER GLEN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60491-9284",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-846-2869",
"PracticeLocationAddressFaxNumber": "708-349-1464",
"EnumerationDate": "04/23/2014",
"LastUpdateDate": "04/23/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PANOZZO",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "LICENSE CLINICAL SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "708-846-2869",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "149.012262",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}