Active NPI
Otis Mack II, LMSW
- Social Worker
- Brooklyn, NY
National Provider Identifier
1083827760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 072983-1
- Practice address
- 606 Winthrop St
'G' Building
Brooklyn, NY 11203-1709 - Phone
- (718) 245-2348
- Fax
- (718) 245-2416
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 072983-1 | NY | Primary |
Addresses
Primary practice location
606 Winthrop St
'G' Building
Brooklyn, NY 11203-1709
Mailing address
25924 147TH Ave
PVT. H.
Rosedale, NY 11422-3321
Phone (718) 525-2923
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 |
|---|---|---|---|
| 072983-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083827760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25924 147TH AVE",
"address_2": "PVT. H.",
"city": "ROSEDALE",
"state": "NY",
"postal_code": "114223321",
"telephone_number": "718-525-2923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 WINTHROP ST",
"address_2": "'G' BUILDING",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112031709",
"telephone_number": "718-245-2348",
"fax_number": "718-245-2416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "OTIS",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "072983-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.