Individual provider Active NPI

Carol Joan McKinney, LMSW, CASAC-T

  • Clinical Social Worker
  • Amityville, NY
National Provider Identifier
1114415775
Registry record updated Apr 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
103448 Issued in NY
Practice address
37 John St
Amityville, NY 11701-2930
Phone
(631) 424-2900
Fax
(631) 608-1057
NPI assigned
Apr 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2018

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 103448 NY
Addiction (Substance Use Disorder) Counselor 101YA0400X 103448 NY
Mental Health Counselor 101YM0800X 103448 NY
Professional Counselor 101YP2500X 103448 NY
Social Worker 104100000X 103448 NY
Marriage & Family Therapist 106H00000X 103448 NY
Clinical Social Worker 1041C0700X 103448 NY Primary

Addresses

Primary practice location

37 John St
Amityville, NY 11701-2930

Mailing address

46 Walter Ave
Hicksville, NY 11801-5345
Phone (646) 404-4061

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
103448NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Seafield Center Past Accepting new patients

Organizations & group practices 1

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": "1524873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524873600000",
    "number": "1114415775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 WALTER AVE",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118015345",
            "telephone_number": "646-404-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 JOHN ST",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012930",
            "telephone_number": "631-424-2900",
            "fax_number": "631-608-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNEY",
        "first_name": "CAROL",
        "middle_name": "JOAN",
        "credential": "LMSW, CASAC-T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-28",
        "last_updated": "2018-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "103448",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "103448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amityville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.