{"npi":"1376087635","type":"NPI-2","status":"active","name":{"display":"Premier Wellness Healthcare","other":[],"organization_name":"PREMIER WELLNESS HEALTHCARE","authorised_official":"Cynthia Dicara"},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"101YM0800X","description":"Mental Health Counselor","primary":false,"state":null,"license":null},{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2209 COMMERCE RD STE 1","city":"FOREST HILL","state":"MD","postal_code":"210502539","country_code":"US","phone":"8883331345","fax":"4107342025"},{"purpose":"MAILING","street_1":"133 BLACK OAK TRL","city":"DELTA","state":"PA","postal_code":"173148756","country_code":"US"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"7635036-00","state":"MD","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20170517000801","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MD","pac_id":"1052688389"}]},"enumeration_date":"2016-12-06","last_updated":"2026-06-09","_meta":{"source":"NPPES","snapshot_date":"2026-06-09","doc_url":"https://findmynpi.com/api"}}