{
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"FirstLineMailingAddress": "747 52ND STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKLAND",
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"MailingAddressPostalCode": "94609-1809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-428-3885",
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"FirstLinePracticeLocationAddress": "2607 MYRTLE ST",
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"PracticeLocationAddressCityName": "OAKLAND",
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"EnumerationDate": "04/13/2011",
"LastUpdateDate": "09/05/2024",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDBERG",
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"AuthorizedOfficialCredential": "PSYD",
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"Taxonomies": {
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"TaxonomyName": "Student Health Clinic/Center",
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}
},
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}
}