Individual provider Active NPI

Juan R Ceron

  • Mental Health Counselor
  • Brooklyn, NY
National Provider Identifier
1093087587
Registry record updated Jan 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
084182-1 Issued in NY
Practice address
1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone
(718) 375-1200
Fax
(718) 382-3358
NPI assigned
Jan 31, 2012
Last updated
Jan 31, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 084182-1 NY Primary

Addresses

Primary practice location

1623 Kings Hwy
Brooklyn, NY 11229-1209

Mailing address

1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone (718) 375-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180201002367 NY Practitioner - Clinical Social Worker 5193085645 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone 9292737601426

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
084182-1NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespire, Inc. CurrentSince Oct 21, 2018 Accepting new patients
Lifespire, Inc. CurrentSince Oct 21, 2018 Accepting new patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Nov 1, 2017 Accepting new patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Nov 1, 2017 Accepting new patients

Locations

21301 Northern Blvd
Fl 2
Bayside, NY 11361
Phone (718) 721-5444

1623 Kings Hwy
Brooklyn, NY 11229
Phone (718) 307-6800

16210 Jamaica Ave
Ste 7
Jamaica, NY 11432
Phone (718) 454-2700

159 E 125th St
Fl 2
New York, NY 10035
Phone (212) 360-5600

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1327968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327968000000",
    "number": "1093087587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291209",
            "telephone_number": "718-375-1200",
            "fax_number": "718-382-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291209",
            "telephone_number": "718-375-1200",
            "fax_number": "718-382-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERON",
        "first_name": "JUAN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-31",
        "last_updated": "2012-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "084182-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.