Roseanne McKinnon

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

003679 Issued in CT

Practice address

200 Cornwall Bridge Rd
Sharon, CT 06069

Phone

(860) 364-0665

Fax

(860) 364-0665

NPI assigned

Aug 28, 2006

Last updated

May 13, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368403200000",
    "number": "1023126356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORNWALL BRIDGE RD",
            "city": "SHARON",
            "state": "CT",
            "postal_code": "06069",
            "telephone_number": "860-364-0665",
            "fax_number": "860-364-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CORNWALL BRIDGE RD",
            "city": "SHARON",
            "state": "CT",
            "postal_code": "06069",
            "telephone_number": "860-364-0665",
            "fax_number": "860-364-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "ROSEANNE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2013-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "003679",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0316121",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "7491794",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "140003679CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004211827",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maple Emergency Physicians, LLC
• Kimberly Gregg Markel, DPT
• Carl D Marshall, LICENSED OPTICIAN
• Daniel C Marshall, L.O.
• Mark J. Marshall, D.O.
• Tamar Rae Melin, NP
• Sarah Merwin, APRN
• Charles S Mirabile Jr., MD
• Michelle Marie Mojon, OTR
• Carola Monroe, PT

• Clinical Social Worker in Sharon, CT
• Providers in Sharon, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.