Active NPI
Timmy J.K. So, LCSW-R
- Social Worker
- Buffalo, NY
National Provider Identifier
1174806442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 083303
- Practice address
- 462 Grider St
Buffalo, NY 14215-3098 - Phone
- (716) 898-4560
- NPI assigned
- Sep 23, 2011
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | |||
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 083303 | NY | |
| Counseling Psychologist | 103TC1900X | 083303 | NY | |
| Clinical Social Worker | 1041C0700X | 086100 | NY | |
| Social Worker | 104100000X | 083303 | NY | Primary |
Addresses
Primary practice location
462 Grider St
Buffalo, NY 14215-3098
Mailing address
1001 11TH St.
Northpointe Council, Inc
Niagra Falls, NY 14301
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00932467 | Medicaid | NY |
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 |
|---|---|---|---|
| 086100 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1174806442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 11TH ST.",
"address_2": "NORTHPOINTE COUNCIL, INC",
"city": "NIAGRA FALLS",
"state": "NY",
"postal_code": "14301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 GRIDER ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142153098",
"telephone_number": "716-898-4560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SO",
"first_name": "TIMMY",
"middle_name": "J.K.",
"name_prefix": "Mr.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-23",
"last_updated": "2021-07-08",
"certification_date": "2021-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "083303",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NY",
"license": "083303",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "086100",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "083303",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00932467",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.