Active NPI
Christine Deriso
- Clinical Social Worker
- Hicksville, NY
National Provider Identifier
1265747133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 081188
- Practice address
- 950 S Oyster Bay Rd
Hicksville, NY 11801-3510 - Phone
- (516) 348-0285
- Fax
- (516) 348-0288
- NPI assigned
- Aug 16, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 081188 | NY | Primary |
Addresses
Primary practice location
950 S Oyster Bay Rd
Hicksville, NY 11801-3510
Mailing address
950 S Oyster Bay Rd
Hicksville, NY 11801-3510
Phone (516) 348-0285
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00081188 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 081188 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281916800000",
"number": "1265747133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 S OYSTER BAY RD",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118013510",
"telephone_number": "516-348-0285",
"fax_number": "516-348-0288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 S OYSTER BAY RD",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118013510",
"telephone_number": "516-348-0285",
"fax_number": "516-348-0288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERISO",
"first_name": "CHRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-16",
"last_updated": "2010-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "081188",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00081188",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hicksville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.