Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | PR002558-1 | NEW YORK | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 62-27877 | OTHER | NEW YORK | UNITED PROVIDER |
| 2 | 4582707 | OTHER | NEW YORK | AETNA PROVIDER |
| 3 | 524039 | MEDICARE UPIN | NEW YORK | |
| 4 | 216754 | OTHER | NEW YORK | MHN PROVIDER |
| 5 | P11112603 | OTHER | NEW YORK | MULTIPLAN PROVIDER |
| 6 | 02037736 | MEDICAID | NEW YORK | |
| 7 | 749-3797 OR 0049001 | OTHER | NEW YORK | GHI PROVIDER |
| 8 | WS963 | OTHER | NEW YORK | OXFORD PROVIDER |
| 9 | 135448 | OTHER | NEW YORK | VALUE OPTIONS PROVIDER |
| 10 | N04101 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE/EMPIRE PROVIDER |
| 11 | 363942 | OTHER | NEW YORK | MVP PROVIDER |
| 12 | 10764-17806 | OTHER | NEW YORK | CMS PROVIDER |
