Active NPI
Luis R Fagundes, LCSW
- Community Health Worker
- New York, NY
National Provider Identifier
1033418983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 078325
- Practice address
- 462 1St Ave
New York, NY 10016-9196 - Phone
- (212) 562-4679
- NPI assigned
- Mar 17, 2011
- Last updated
- Sep 20, 2018
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 078325 | NY | Primary |
Addresses
Primary practice location
462 1St Ave
New York, NY 10016-9196
Mailing address
248 W 108TH St
New York, NY 10025-2956
Phone (212) 562-4679
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 |
|---|---|---|---|
| 078325 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1033418983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 W 108TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252956",
"telephone_number": "212-562-4679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 1ST AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100169196",
"telephone_number": "212-562-4679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGUNDES",
"first_name": "LUIS",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-17",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "078325",
"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 Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.