Active NPI
Autumn Talley
- Clinical Social Worker
- Jackson Heights, NY
National Provider Identifier
1144795790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- T02960696961931
- Practice address
- 9114 37TH Ave
Jackson Heights, NY 11372-7920 - Phone
- (718) 779-1600
- Fax
- (347) 612-4162
- NPI assigned
- Oct 10, 2018
- Last updated
- Oct 10, 2018
- Sex
- Female
- Sole proprietor
- No
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 | T02960696961931 | NJ | Primary |
Addresses
Primary practice location
9114 37TH Ave
Jackson Heights, NY 11372-7920
Mailing address
9114 37TH Ave
Jackson Heights, NY 11372-7920
Phone (718) 779-1600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T02960696961931 | Medicaid | NJ |
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
| License | State | Type | Specialty |
|---|---|---|---|
| T02960696961931 | NJ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539129600000",
"number": "1144795790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9114 37TH AVE",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113727920",
"telephone_number": "718-779-1600",
"fax_number": "347-612-4162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9114 37TH AVE",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113727920",
"telephone_number": "718-779-1600",
"fax_number": "347-612-4162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALLEY",
"first_name": "AUTUMN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-10",
"last_updated": "2018-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "T02960696961931",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "T02960696961931",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.