Individual provider Active NPI

Marian O Connor, LCSW

  • Clinical Social Worker
  • New Windsor, NY
National Provider Identifier
1376502252
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R0242651 Issued in NY
Practice address
555 Blooming Grove Turnpike
New Windsor, NY 12553-7843
Phone
(845) 562-0487
Fax
(845) 238-5681
NPI assigned
Mar 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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 R0242651 NY Primary

Addresses

Primary practice location

555 Blooming Grove Turnpike
New Windsor, NY 12553-7843

Mailing address

555 Blooming Grove Turnpike
New Windsor, NY 12553-7843
Phone (845) 562-0487

Other identifiers 2

IdentifierTypeStateIssuer
7400120OtherGHI
N37741OtherEMPIRE BLUE CROSS

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
I20060215000017 NY Practitioner - Clinical Social Worker 4082629811 Practice locations: Monroe, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Monroe, NY 10950
Phone (845) 562-0487

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
024265NYMDClinical Psychologist
R0242651NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1376502252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 BLOOMING GROVE TURNPIKE",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125537843",
            "telephone_number": "845-562-0487",
            "fax_number": "845-238-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 BLOOMING GROVE TURNPIKE",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125537843",
            "telephone_number": "845-562-0487",
            "fax_number": "845-238-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O CONNOR",
        "first_name": "MARIAN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-21",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0242651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "7400120",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE CROSS",
            "identifier": "N37741",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Windsor, NY

Sources for this page

Verify at the official NPI Registry.