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 | 104100000X | Social Worker | | 072486 | NEW YORK | No |
| 2 | 1041C0700X | Social Worker | Clinical | LC23140 | MAINE | No |
| 3 | 1041C0700X | Social Worker | Clinical | 0904015217 | VIRGINIA | No |
| 4 | 1041C0700X | Social Worker | Clinical | LICSW1120580 | MASSACHUSETTS | No |
| 5 | 1041C0700X | Social Worker | Clinical | 44SC06082500 | NEW JERSEY | No |
| 6 | 1041C0700X | Social Worker | Clinical | TPSW1585 | FLORIDA | No |
| 7 | 1041C0700X | Social Worker | Clinical | 089.0135391TELE | VERMONT | No |
| 8 | 1041C0700X | Social Worker | Clinical | TLS425CP | SOUTH CAROLINA | No |
| 9 | 1041C0700X | Social Worker | Clinical | TH00946707 | WEST VIRGINIA | No |
| 10 | 1041C0700X | Social Worker | Clinical | Q5-0000089 | DELAWARE | No |
| 11 | 1041C0700X | Social Worker | Clinical | 082913 | 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 | 44SC06082500 | OTHER | NEW JERSEY | LCSW LICENSE NUMBER |
| 2 | Q5-0000089 | OTHER | DELAWARE | OUT-OF-STATE TELEHEALTH PROVIDER |
| 3 | TPSW1585 | OTHER | FLORIDA | OUT-OF-STATE TELEHEALTH PROVIDER |
| 4 | 0904015217 | OTHER | VIRGINIA | LCSW LICENSE NUMBER |
| 5 | 082913 | OTHER | NEW YORK | LCSW LICENSE NUMBER |
| 6 | 089.0135391TELE | OTHER | VERMONT | OUT-OF-STATE TELEHEALTH PROVIDER |
| 7 | LC23140 | OTHER | MAINE | LCSW LICENSE NUMBER |
| 8 | TH00946707 | OTHER | WEST VIRGINIA | OUT-OF-STATE TELEHEALTH PROVIDER |
| 9 | TLS425CP | OTHER | SOUTH CAROLINA | OUT-OF-STATE TELEHEALTH PROVIDER |
| 10 | LICSW1120580 | OTHER | MASSACHUSETTS | LICSW NUMBER |
