Active NPI
Derrick R Polite, LMSW CASAC-T
- Social Worker
- Jamaica, NY
National Provider Identifier
1023376084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 72 085056
- Practice address
- 89-31 161TH Street
Jamaica, NY 11432 - Phone
- (718) 206-0218
- Fax
- (718) 206-1091
- NPI assigned
- Apr 27, 2012
- Last updated
- Apr 27, 2012
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 72 085056 | NY | Primary |
Addresses
Primary practice location
89-31 161TH Street
Jamaica, NY 11432
Mailing address
89-31 161TH Street
St. Vincent Services
Jamaica, NY 11432
Phone (718) 206-0218
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72 085056 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335484800000",
"number": "1023376084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "89-31 161TH STREET",
"address_2": "ST. VINCENT SERVICES",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11432",
"telephone_number": "718-206-0218",
"fax_number": "718-206-1091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "89-31 161TH STREET",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11432",
"telephone_number": "718-206-0218",
"fax_number": "718-206-1091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLITE",
"first_name": "DERRICK",
"middle_name": "R",
"credential": "LMSW CASAC-T",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-27",
"last_updated": "2012-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "72 085056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.