Active NPI
Michelle Terry
- Clinical Social Worker
- New York, NY
National Provider Identifier
1114339504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R056116-1
- Practice address
- 308 E 79TH St Apt 10Ef
New York, NY 10075-0998 - Phone
- (914) 548-6388
- NPI assigned
- May 20, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | R056116-1 | NY | |
| Clinical Social Worker | 1041C0700X | R056116-1 | NY | Primary |
Addresses
Primary practice location
308 E 79TH St Apt 10Ef
New York, NY 10075-0998
Mailing address
308 E 79TH St Apt 10Ef
New York, NY 10075-0998
Phone (914) 548-6388
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R056116-1 | NY | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1114339504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 E 79TH ST APT 10EF",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100750998",
"telephone_number": "914-548-6388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 E 79TH ST APT 10EF",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100750998",
"telephone_number": "914-548-6388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERRY",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-20",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "NY",
"license": "R056116-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R056116-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.