Active NPI
Marissa Sherov, LCSW
- Clinical Social Worker
- Melville, NY
National Provider Identifier
1184856049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 079577-1
- Practice address
- 900 Walt Whitman Rd Ste 304
Melville, NY 11747-2215 - Phone
- (516) 661-2122
- NPI assigned
- Aug 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 079577-1 | NY | |
| Clinical Social Worker | 1041C0700X | 079577-1 | NY | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X |
Addresses
Primary practice location
900 Walt Whitman Rd Ste 304
Melville, NY 11747-2215
Mailing address
900 Walt Whitman Rd Ste 304
Melville, NY 11747-2215
Phone (516) 661-2122
Other practice location 1
55 Horizon Drive
Pederson-Krag Center
Huntington, NY 11743
Phone (631) 920-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01420795 | 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 |
|---|---|---|---|
| 079577-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552608000000",
"number": "1184856049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 WALT WHITMAN RD STE 304",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472215",
"telephone_number": "516-661-2122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 WALT WHITMAN RD STE 304",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472215",
"telephone_number": "516-661-2122"
}
],
"practiceLocations": [
{
"address_1": "55 Horizon Drive",
"address_2": "Pederson-Krag Center",
"address_purpose": "LOCATION",
"city": "Huntington",
"state": "NY",
"postal_code": "11743",
"country_code": "US",
"telephone_number": "631-920-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHEROV",
"first_name": "MARISSA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-11",
"last_updated": "2019-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "079577-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "079577-1",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01420795",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.