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 | R047691 | 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 | 000526001001 | OTHER | | COMM CARE MEDICAID MGD C |
| 2 | 000526001001 | OTHER | | HMO 100 |
| 3 | 000526001001 | OTHER | | SECURE BLUE PPO |
| 4 | 000526001001 | OTHER | | BCBS WNY |
| 5 | 050730000006 | OTHER | | FIDELIS CHILD HEALTH PLUS |
| 6 | 143930 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 7 | 01465154 | MEDICAID | NEW YORK | |
| 8 | 00011249905 | OTHER | | ASO |
| 9 | 000526001001 | OTHER | | SECURE BLUE INDEMNITY |
| 10 | 050730000006 | OTHER | | FIDELIS FAMILY HEALTH PLS |
| 11 | 000526001001 | OTHER | | CB LABOR HEALTH HMO |
| 12 | 000526001001 | OTHER | | FAMILY HEALTH PLUS |
| 13 | 000526001001 | OTHER | | SECURE BLUE POS |
| 14 | 000526001001 | OTHER | | COMMUNITY BLUE STD HMO |
| 15 | 050730000006 | OTHER | | FIDELIS MEDICAID |
| 16 | 000526001001 | OTHER | | CB ADVANTAGE HMO |
| 17 | 000526001001 | OTHER | | CHILD HEALTH PLUS |
| 18 | 000526001001 | OTHER | | SENIOR BLUE HMO |
| 19 | 000526001001 | OTHER | | HEALTHLY NY |
