Active NPI
Jeffrey Michael Deroche, LCSW
- Clinical Social Worker
- New York, NY
National Provider Identifier
1205275047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 73 084674
- Practice address
- 230 W 17TH St
Fifth Floor
New York, NY 10011-5325 - Phone
- (212) 271-7200
- NPI assigned
- Jun 14, 2013
- Last updated
- Sep 1, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | NU | ||
| Clinical Social Worker | 1041C0700X | 73 084674 | NY | Primary |
Addresses
Primary practice location
230 W 17TH St
Fifth Floor
New York, NY 10011-5325
Mailing address
162 Washington Park
Apt. 4
Brooklyn, NY 11205-3234
Phone (917) 280-6440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 6, 2024 through Jan 6, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73 084674 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1205275047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "162 WASHINGTON PARK",
"address_2": "APT. 4",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112053234",
"telephone_number": "917-280-6440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 W 17TH ST",
"address_2": "FIFTH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100115325",
"telephone_number": "212-271-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROCHE",
"first_name": "JEFFREY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-14",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "73 084674",
"primary": true
}
],
"identifiers": [],
"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 Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.