Intentional Impact LMSW PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INTENTIONAL IMPACT LMSW PLLC

Practice address

1350 Buffalo Rd Ste 18
Rochester, NY 14624-1856

Phone

(585) 290-2224

NPI assigned

Apr 25, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Caswell Vincent Smith, LMSWNPI 1215586920

Title

Owner

Phone

(585) 290-2224

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Caswell Vincent Smith

  • Clinical Social Worker
  • Rochester, NY
  • NPI 1215586920
  NPD Authorized official

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

{
    "created_epoch": "1619308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619308800000",
    "number": "1154903540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 CEDARWOOD TER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146097154",
            "telephone_number": "585-290-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 BUFFALO RD STE 18",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146241856",
            "telephone_number": "585-290-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL IMPACT LMSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-25",
        "last_updated": "2021-04-25",
        "certification_date": "2021-04-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CASWELL",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-290-2224",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://intentional-impact-lmsw-pllc.clientsecure.me/",
            "affiliation": "N",
            "endpointDescription": "Simple Practice",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1350 Buffalo Rd Ste 18",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146241856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Rochester, NY
• Providers in Rochester, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2021; 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.