Individual provider Active NPI

Mary Bromley, LCSW

  • Clinical Social Worker
  • East Hampton, NY
National Provider Identifier
1154511608
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R22346 Issued in NY
Practice address
62 Newtown LN
East Hampton, NY 11937-2494
Phone
(631) 324-8720
Fax
(631) 329-3135
NPI assigned
Jul 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R22346 NY Primary

Addresses

Primary practice location

62 Newtown LN
East Hampton, NY 11937-2494

Mailing address

62 Newtown LN
East Hampton, NY 11937-2494
Phone (631) 324-8720

Other identifiers 1

IdentifierTypeStateIssuer
AA49106OtherNYMDNY

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
R22346NYMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185840000000",
    "number": "1154511608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 NEWTOWN LN",
            "city": "EAST HAMPTON",
            "state": "NY",
            "postal_code": "119372494",
            "telephone_number": "631-324-8720",
            "fax_number": "631-329-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 NEWTOWN LN",
            "city": "EAST HAMPTON",
            "state": "NY",
            "postal_code": "119372494",
            "telephone_number": "631-324-8720",
            "fax_number": "631-329-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROMLEY",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-31",
        "last_updated": "2007-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R22346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDNY",
            "identifier": "AA49106",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hampton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; 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.