Individual provider Active NPI

Michele Demko Mauro, LCSW-R

  • Clinical Social Worker
  • New York, NY
National Provider Identifier
1174880504
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R069695 Issued in NY
Practice address
26 W 9TH St
Suite 7E
New York, NY 10011-8971
Phone
(516) 456-2424
Fax
(631) 286-2342
NPI assigned
Apr 23, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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 R069695 NY Primary

Addresses

Primary practice location

26 W 9TH St
Suite 7E
New York, NY 10011-8971

Mailing address

26 W 9TH St
Suite 7E
New York, NY 10011-8971
Phone (516) 456-2424

Other identifiers 1

IdentifierTypeStateIssuer
P3249515OtherNYOXFORD PROVIDER ID

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
R069695NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1174880504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 W 9TH ST",
            "address_2": "SUITE 7E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118971",
            "telephone_number": "516-456-2424",
            "fax_number": "631-286-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 W 9TH ST",
            "address_2": "SUITE 7E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118971",
            "telephone_number": "516-456-2424",
            "fax_number": "631-286-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAURO",
        "first_name": "MICHELE",
        "middle_name": "DEMKO",
        "name_prefix": "Mrs.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R069695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD PROVIDER ID",
            "identifier": "P3249515",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.