Individual provider Active NPI

Matthew Desrosiers, LCSW

  • Clinical Social Worker
  • New York, NY
National Provider Identifier
1104295344
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09929397 Issued in CO
Practice address
32 Broadway
Suite 200
New York, NY 10004-1609
Phone
(212) 951-6866
NPI assigned
Sep 17, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW.09929397 CO Primary
Clinical Social Worker 1041C0700X 090921 NY

Addresses

Primary practice location

32 Broadway
Suite 200
New York, NY 10004-1609

Mailing address

PO Box 110429
Aurora, CO 80042-0429

Other practice location 1

1890 N Revere Ct
Aurora, CO 80045-7464
Phone (720) 848-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20230829001137 CO Practitioner - Clinical Social Worker 7618330317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

1890 N Revere CT
Helen and Arthur E Johnson Cu Depression Ce
Aurora, CO 80045-2570
Phone (303) 724-3300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CSW.09929397COMDClinical Social Worker
090921NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians, Incorporated CurrentSince Sep 1, 2023 Accepting new patients
University Physicians Incorporated Current Accepting new patients
University Physicians, Incorporated CurrentSince Sep 1, 2023 Accepting new patients

Locations

1890 N Revere Ct
Aurora, CO 80045
Phone (303) 724-1000

1890 N Revere Ct
Ste 4020
Aurora, CO 80045
Phone (303) 724-1000

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

Dept 1061
Denver, CO 80256

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1104295344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 BROADWAY",
            "address_2": "SUITE 200",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100041609",
            "telephone_number": "212-951-6866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1890 N Revere Ct",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800457464",
            "country_code": "US",
            "telephone_number": "720-848-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESROSIERS",
        "first_name": "MATTHEW",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-17",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09929397",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "090921",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.