NPIMap

Organization Active NPI

Maverick Family Counseling LCSW PLLC

Doing business as Maverick Family Counseling

  • Clinical Social Worker
  • Woodstock, NY
National Provider Identifier
1104160738
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MAVERICK FAMILY COUNSELING LCSW PLLC
Doing business as
Maverick Family Counseling
Practice address
404 Zena Rd
Woodstock, NY 12498-2626
Phone
(845) 679-8650
Fax
(845) 679-5485
NPI assigned
Nov 20, 2012
Last updated
Nov 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

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

Authorized official

Name
Mr. Thayer Case, LCSWNPI 1861778292
Title
Co-Director
Phone
(845) 679-8650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

404 Zena Rd
Woodstock, NY 12498-2626

Mailing address

404 Zena Rd
Woodstock, NY 12498-2626
Phone (845) 679-8650

Other names 1

  • Maverick Family Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131203002090 NY Part B Supplier - Clinic/Group Practice 1557597184 Receives reassigned benefits from 26 practitioners
Practice locations: Margaretville, NY; Phoenicia, NY; Woodstock, NY

National Provider Directory

National Provider Directory

Locations

90 Main St
Ste 2A
Phoenicia, NY 12464
Phone (845) 688-7015

404 Zena Rd
Woodstock, NY 12498
Phone (845) 679-5271

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1104160738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "124982626",
            "telephone_number": "845-679-8650",
            "fax_number": "845-679-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "124982626",
            "telephone_number": "845-679-8650",
            "fax_number": "845-679-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK FAMILY COUNSELING LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-20",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "CASE",
        "authorized_official_first_name": "THAYER",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "845-679-8650",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maverick Family Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.