{
  "npi": "1346927308",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "LCSW",
    "authorized_official_first_name": "AMY",
    "authorized_official_last_name": "STARK",
    "authorized_official_middle_name": "J.",
    "authorized_official_telephone_number": "3149715272",
    "authorized_official_title_or_position": "Therapist/Manager/Sole Member",
    "certification_date": "2023-06-30",
    "enumeration_date": "2023-06-30",
    "last_updated": "2023-06-30",
    "organization_name": "AMY J. STARK, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "9666 OLIVE BLVD STE 370",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "OLIVETTE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "631323025",
      "state": "MO",
      "telephone_number": "314-971-5272"
    },
    {
      "address_1": "729 CHIPPENDALE CT",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "KIRKWOOD",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "631225705",
      "state": "MO",
      "telephone_number": "314-971-5272"
    }
  ],
  "taxonomies": [
    {
      "code": "1041C0700X",
      "desc": "Social Worker, Clinical",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193400000X - Single Specialty Group"
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "80",
        "medicare_type": "Licensed Clinical Social Worker"
      }
    ]
  }
}