Active NPI
Philbert Walcott, CASAC
- Addiction (Substance Use Disorder) Counselor
- New York, NY
National Provider Identifier
1013336262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 17361
- Practice address
- 177 East 122ND Street
New York, NY 10035 - Phone
- (212) 360-7116
- Fax
- (212) 829-5156
- NPI assigned
- Apr 15, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17361 | NY | Primary |
Addresses
Primary practice location
177 East 122ND Street
New York, NY 10035
Mailing address
3422 Knox Place
Apt. 2B
Bronx, NY 10467
Phone (718) 881-3905
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 |
|---|---|---|---|
| 17361 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397520000000",
"number": "1013336262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3422 KNOX PLACE",
"address_2": "APT. 2B",
"city": "BRONX",
"state": "NY",
"postal_code": "10467",
"telephone_number": "718-881-3905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 EAST 122ND STREET",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10035",
"telephone_number": "212-360-7116",
"fax_number": "212-829-5156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALCOTT",
"first_name": "PHILBERT",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-15",
"last_updated": "2014-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "17361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.