Active NPI
Angelia A Mack, LMSW
- Social Worker
- Auburn, NY
National Provider Identifier
1043989148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 080018-01
- Practice address
- 4144 Baptist Corner Rd
Auburn, NY 13021-9355 - Phone
- (315) 657-5850
- NPI assigned
- Sep 10, 2021
- Sex
- Female
- 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 | 080018-01 | NY | Primary |
Addresses
Primary practice location
4144 Baptist Corner Rd
Auburn, NY 13021-9355
Mailing address
4144 Baptist Corner Rd
Auburn, NY 13021-9355
Phone (315) 657-5850
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 |
|---|---|---|---|
| 080018-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1043989148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4144 BAPTIST CORNER RD",
"city": "AUBURN",
"state": "NY",
"postal_code": "130219355",
"telephone_number": "315-657-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4144 BAPTIST CORNER RD",
"city": "AUBURN",
"state": "NY",
"postal_code": "130219355",
"telephone_number": "315-657-5850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "ANGELIA",
"middle_name": "A",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-10",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "080018-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.