Phoenix Rising Therapeutic Services LCSW PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R045595-1 Issued in NY

Legal business name

PHOENIX RISING THERAPEUTIC SERVICES LCSW PC

Practice address

5295 E Valley Rd
Alfred Station, NY 14803-9715

Phone

(607) 587-8260

NPI assigned

May 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Beth McDonough, LCSW-RNPI 1265442495

Title

Sole Owner

Phone

(607) 587-8260

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Beth McDonough, CSWR-R

  • Clinical Social Worker
  • Hornell, NY
  • NPI 1265442495
  Medicare reassignment NPD Authorized official
• Sydney McDonough

  • Physical Therapist
  • Anchorage, AK
  • NPI 1922760925
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1003295395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5295 E VALLEY RD",
            "city": "ALFRED STATION",
            "state": "NY",
            "postal_code": "148039715",
            "telephone_number": "607-587-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5295 E VALLEY RD",
            "city": "ALFRED STATION",
            "state": "NY",
            "postal_code": "148039715",
            "telephone_number": "607-587-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING THERAPEUTIC SERVICES LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "MCDONOUGH",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "607-587-8260",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R045595-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel G Cali, LMHC
• Laertes C Cushing
• Rachel Anne Gardner, PH.D.
• Pamela Pitt Jones, FNP C
• Sylvia Kelley Knowlton, M.D.
• Norman James Pollard, ED.D.
• Cody James Prince, FNP
• Southern Tier Psychology, PC
• Southern Tier Psychology, PC
• Michael Wales, MASTER SCHOOL PSYCH

• Clinical Social Worker in Alfred Station, NY
• Providers in Alfred Station, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.