{
"Npi": {
"NPI": "1992231187",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WICKARD",
"FirstName": "PAGET",
"MiddleName": "BRIDGET",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCCARTHY",
"OtherFirstName": "PAGET",
"OtherMiddleName": null,
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "827 CRAWFORD RUN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHESWICK",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15024-2423",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-245-6145",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "DORSEYVILLE ALLIANCE CHURCH 3703 SAXONBURG BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PITTSBURGH",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15238",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-423-5802",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/07/2017",
"LastUpdateDate": "05/17/2024",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "PS018543",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}