Individual provider Active NPI

Santos . Rivera Jr., DSW

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1205056751
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R23377-1 Issued in NY
Practice address
1048 49TH St
Brooklyn, NY 11219-2917
Phone
(718) 438-8561
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 R23377-1 NY Primary

Addresses

Primary practice location

1048 49TH St
Brooklyn, NY 11219-2917

Mailing address

761 49TH St
Brooklyn, NY 11220-2206
Phone (718) 438-8561

Other identifiers 1

IdentifierTypeStateIssuer
R23377-1OtherNYNYS LICENSE NUMBER

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
R23377-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205056751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 49TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202206",
            "telephone_number": "718-438-8561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 49TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192917",
            "telephone_number": "718-438-8561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "SANTOS",
        "middle_name": ".",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R23377-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE NUMBER",
            "identifier": "R23377-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.