Active NPI
Ennis Karriem-Hassan Hightower, CASAC-T
- Addiction (Substance Use Disorder) Counselor
- Valley Stream, NY
National Provider Identifier
1154039279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 37199
- Practice address
- 497 Rockaway Ave
Valley Stream, NY 11581-1909 - Phone
- (718) 845-2621
- Fax
- (718) 845-2622
- NPI assigned
- Nov 8, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 37199 | NY | Primary |
Addresses
Primary practice location
497 Rockaway Ave
Valley Stream, NY 11581-1909
Mailing address
15135 84TH St Apt 1H
Howard Beach, NY 11414-1823
Phone (347) 316-6979
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 |
|---|---|---|---|
| 37199 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667865600000",
"number": "1154039279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15135 84TH ST APT 1H",
"city": "HOWARD BEACH",
"state": "NY",
"postal_code": "114141823",
"telephone_number": "347-316-6979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "497 ROCKAWAY AVE",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115811909",
"telephone_number": "718-845-2621",
"fax_number": "718-845-2622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIGHTOWER",
"first_name": "ENNIS",
"middle_name": "KARRIEM-HASSAN",
"credential": "CASAC-T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-08",
"last_updated": "2022-11-08",
"certification_date": "2022-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "37199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.