Individual provider Active NPI

John Peter Estabrook, MSW

  • Clinical Social Worker
  • Canandaigua, NY
National Provider Identifier
1295777217
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R042184 Issued in NY
Practice address
42 N Main St
Canandaigua, NY 14424-1446
Phone
(585) 919-0014
Fax
(585) 393-0014
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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 R042184 NY Primary

Addresses

Primary practice location

42 N Main St
Canandaigua, NY 14424-1446

Mailing address

2 Pinewood LN
Naples, NY 14512-9286
Phone (585) 531-4030

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
I20150706000009 NY Practitioner - Clinical Social Worker 2264744234 Practice locations: Canandaigua, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

42 N Main St
Canandaigua, NY 14424-1446
Phone (585) 919-0014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R042184NYMDClinical Social Worker
042184NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433203200000",
    "number": "1295777217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PINEWOOD LN",
            "city": "NAPLES",
            "state": "NY",
            "postal_code": "145129286",
            "telephone_number": "585-531-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 N MAIN ST",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241446",
            "telephone_number": "585-919-0014",
            "fax_number": "585-393-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTABROOK",
        "first_name": "JOHN",
        "middle_name": "PETER",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2015-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R042184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canandaigua, NY

Sources for this page

Verify at the official NPI Registry.