{
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"FirstLineMailingAddress": "26777 LORAIN RD STE 314",
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"MailingAddressStateName": "OH",
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"EnumerationDate": "12/19/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARVALD",
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"AuthorizedOfficialCredential": "L.I.S.W.",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}