Active NPI
Andy Debaun, LCSW
- Clinical Social Worker
- Jersey City, NJ
National Provider Identifier
1114128246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 069448
- Practice address
- 207 Warren St
# 3
Jersey City, NJ 07302-4411 - Phone
- (914) 400-3160
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 069448 | NY | Primary |
Addresses
Primary practice location
207 Warren St
# 3
Jersey City, NJ 07302-4411
Mailing address
29 W 76TH St
Apt. 2
New York, NY 10023-1518
Phone (914) 400-3160
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160315002394 | NY | Practitioner - Clinical Social Worker | 0143526277 | Practice locations: New York, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
New York, NY 10004
Phone 91440031600000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455235200000",
"number": "1114128246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 W 76TH ST",
"address_2": "APT. 2",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100231518",
"telephone_number": "914-400-3160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 WARREN ST",
"address_2": "# 3",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073024411",
"telephone_number": "914-400-3160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBAUN",
"first_name": "ANDY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2016-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "069448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
- Girlene Barbon De Paiva Coughlin, R.D.
- Anne De Rosairo, MD
- Angelica Villacorta De Vera
- Rosanne Deangelis, PA-C
- Dear Tooth Fairy Pediatric Dentistry & Family Orthodontics LLC
- Jillian Debenedetto, LCSW
- Dennis Anthony Debernardis, DO
- Christina Marie Dedeo, DO
- Cecille Natalie Lao Dee, PT
- Deepak Shah, MD,PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.