Active NPI
Thomas McClendon
- Clinical Social Worker
- Bay Shore, NY
National Provider Identifier
1164186417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- X-12121
- Practice address
- 43 Millay LN
Bay Shore, NY 11706-4321 - Phone
- (310) 904-9568
- NPI assigned
- Oct 23, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | X-12121 | NM | Primary |
Addresses
Primary practice location
43 Millay LN
Bay Shore, NY 11706-4321
Mailing address
43 Millay LN
Bay Shore, NY 11706-4321
Phone (310) 904-9568
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 |
|---|---|---|---|
| X-12121 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634947200000",
"number": "1164186417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 MILLAY LN",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117064321",
"telephone_number": "310-904-9568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43 MILLAY LN",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117064321",
"telephone_number": "310-904-9568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLENDON",
"first_name": "THOMAS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-23",
"last_updated": "2021-10-23",
"certification_date": "2021-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "X-12121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.