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 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | 10712 | NEW YORK | Yes |
| 2 | 1041C0700X | Social Worker | Clinical | R049140-1 | NEW YORK | X |
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 | 87726 | OTHER | NEW YORK | UN. BEH. HEALTH PROV ID |
| 2 | NG4821 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE ID |
| 3 | 1435082 | OTHER | NEW YORK | CIGNA PROVIDER ID |
| 4 | 2649282 | OTHER | NEW YORK | AETNA PROVIDER ID |
| 5 | P2559539 | OTHER | NEW YORK | OXFORD PROVIDER ID |
| 6 | 02116558 | MEDICAID | NEW YORK | |
| 7 | 42259P | OTHER | NEW YORK | HIP PROVIDER ID |
| 8 | 303899 | OTHER | | MHN |
| 9 | 7480430 | OTHER | NEW YORK | GHI PROVIDER ID |
| 10 | 131751 | OTHER | NEW YORK | VYTRA PROVIDER ID |
| 11 | 161543 MHS | OTHER | NEW YORK | VALUE OPTIONS PROVIDER ID |
| 12 | NX4021 | OTHER | NEW YORK | BLUE CROSS PROVIDER ID |
