Individual provider Active NPI

John Joseph Mullaney, LCSW

  • Clinical Social Worker
  • Ballston Spa, NY
National Provider Identifier
1083058614
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
011317 Issued in NY
Practice address
174 Milton Ave
Apartment 2
Ballston Spa, NY 12020-1452
Phone
(518) 490-2109
NPI assigned
Apr 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 011317 NY Primary

Addresses

Primary practice location

174 Milton Ave
Apartment 2
Ballston Spa, NY 12020-1452

Mailing address

174 Milton Ave
Apartment 2
Ballston Spa, NY 12020-1452
Phone (518) 490-2109

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

LicenseStateTypeSpecialty
011317NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1083058614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 MILTON AVE",
            "address_2": "APARTMENT 2",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120201452",
            "telephone_number": "518-490-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 MILTON AVE",
            "address_2": "APARTMENT 2",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120201452",
            "telephone_number": "518-490-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANEY",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-25",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "011317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballston Spa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.