Active NPI
Ellisa Robin Mimlitsch, LMSW, CASACT
- Social Worker
- Ellenville, NY
National Provider Identifier
1346505740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 088940
- Practice address
- 6 Healthy Way
Ellenville, NY 12428-2157 - Phone
- (845) 647-4500
- NPI assigned
- Jul 11, 2012
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 088940 | NY | Primary |
Addresses
Primary practice location
6 Healthy Way
Ellenville, NY 12428-2157
Mailing address
6 Healthy Way
Ellenville, NY 12428-2157
Phone (845) 647-4500
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088940 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1346505740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 HEALTHY WAY",
"city": "ELLENVILLE",
"state": "NY",
"postal_code": "124282157",
"telephone_number": "845-647-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 HEALTHY WAY",
"city": "ELLENVILLE",
"state": "NY",
"postal_code": "124282157",
"telephone_number": "845-647-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMLITSCH",
"first_name": "ELLISA",
"middle_name": "ROBIN",
"credential": "LMSW, CASACT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-11",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "088940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellenville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.