Roberto Miguel Magallanez, LCSW, LCAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007166A Issued in IN

Practice address

3310 E 10TH St # 4-156
Jeffersonville, IN 47130-7285

Phone

(812) 624-1180

NPI assigned

Sep 8, 2011

Last updated

Oct 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Antidote Recovery LLC

  dba Antidote Recovery

  • Clinical Social Worker
  • Jeffersonville, IN
  • NPI 1467122051

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1316228000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 E 10TH ST # 4-156",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471307285",
            "telephone_number": "812-624-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 E 10TH ST # 4-156",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471307285",
            "telephone_number": "812-624-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGALLANEZ",
        "first_name": "ROBERTO",
        "middle_name": "MIGUEL",
        "credential": "LCSW, LCAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-08",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "34007166A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "5074",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007166A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300062432",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• M Care
• M Care PLLC
• Kathleen Maccool, MS
• Christopher Mackison
• Daniel C Macmillan, M.D.
• Icsah Maginn, RBT
• Diamond Mahdi, RBT
• Allison Valiquett Maher, APRN
• Johana Maldonado
• Abdulraheem Malik

• Clinical Social Worker in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; 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.