Active NPI
Robert William Fasano, LMSW
- Clinical Social Worker
- Syosset, NY
National Provider Identifier
1013190495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 039878
- Practice address
- 175 Jericho Tpke
Suite 115
Syosset, NY 11791-4532 - Phone
- (516) 359-0561
- Fax
- (516) 496-0193
- NPI assigned
- Dec 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 039878 | NY | Primary |
Addresses
Primary practice location
175 Jericho Tpke
Suite 115
Syosset, NY 11791-4532
Mailing address
175 Jericho Tpke
Suite 115
Syosset, NY 11791-4532
Phone (516) 359-0561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039878 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Judy Cooper LCSW PLLC | Clinical | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/9178/brand/1/csg/1/fhir/r4
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197158400000",
"number": "1013190495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 JERICHO TPKE",
"address_2": "SUITE 115",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117914532",
"telephone_number": "516-359-0561",
"fax_number": "516-496-0193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 JERICHO TPKE",
"address_2": "SUITE 115",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117914532",
"telephone_number": "516-359-0561",
"fax_number": "516-496-0193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASANO",
"first_name": "ROBERT",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-09",
"last_updated": "2007-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "039878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syosset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.