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 | R028688-1 | 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 | 7352096 | OTHER | NEW YORK | GHI PROVIDER NUMBER |
| 2 | P3106483 | OTHER | NEW YORK | OXFORD PROVIDER ID NUMBER |
| 3 | 354762P | OTHER | NEW YORK | HIP-HEALTH PLAN OF NY |
| 4 | 000009404875 | OTHER | NEW YORK | PHCS PROVIDER NUMBER |
| 5 | 7197342 | OTHER | NEW YORK | AETNA PROVIDER ID NO/PIN |
| 6 | IPD284025000 | OTHER | NEW YORK | INTEGRATED PROV DATABASE |
| 7 | NX3651 | MEDICARE PIN | NEW YORK | |
| 8 | 9542EC | OTHER | NEW YORK | GHI MEDICARE PTAN |
| 9 | R28157 | MEDICARE UPIN | NEW YORK | |
| 10 | 2826093000 | OTHER | | AMERIHEALTH PROVIDER ID |
| 11 | 556866 | OTHER | NEW YORK | VALUE OPTIONS PROVIDER NO |
| 12 | 11567232 | OTHER | | CAQH PROVIDER ID |
| 13 | A26820 | OTHER | | 1199 SEIU BENEFIT FUND |
| 14 | IP568045 | OTHER | NEW YORK | MAGELLAN INDV PROVIDER NO |
