Individual provider Active NPI

Mayra Hernandez

  • Clinical Social Worker
  • Central Islip, NY
National Provider Identifier
1245705680
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
097740-01 Issued in NY
Practice address
320 Carleton Ave
Central Islip, NY 11722-4506
Phone
(631) 663-4324
NPI assigned
Oct 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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 097740-01 NY Primary

Addresses

Primary practice location

320 Carleton Ave
Central Islip, NY 11722-4506

Mailing address

320 Carleton Ave
Central Islip, NY 11722-4506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240702001045 NY Practitioner - Clinical Social Worker 1153865183 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aid to the Developmentally Disabled IncGroup PAC ID 1658762182, 8 clinicians

Practice addresses (Care Compare)

901 E Main St
Suite 508
Riverhead, NY 11901-2680
Phone (631) 727-6220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
097740NYMDSocial Worker
097740-01NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Aid to the Developmentally Disabled, Inc CurrentSince Aug 19, 2024 Accepting new patients
Family Service League, Inc. CurrentSince May 24, 2024 Accepting new patients

Locations

320 Carleton Ave
Central Islip, NY 11722
Phone (631) 234-7807

790 Park Ave
Huntington, NY 11743
Phone (631) 427-3700

901 E Main St
Ste 508
Riverhead, NY 11901
Phone (631) 727-6220

901 E Main St
Ste 500
Riverhead, NY 11901
Phone (631) 727-6220

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1245705680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224506",
            "telephone_number": "631-663-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "MAYRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-12",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "097740-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Islip, NY

Sources for this page

Verify at the official NPI Registry.