Therapist Without Borders

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

083105 Issued in NY

Legal business name

THERAPIST WITHOUT BORDERS

Practice address

210 E Main St Ste 304
Middletown, NY 10940-4038

Phone

(845) 566-0286

NPI assigned

Oct 18, 2017

Organization subpart

No

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

Authorized official

Name

Kelly-Ann Fairweather, LCSWNPI 1275829442

Title

Owner

Phone

(347) 512-3636

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly-Ann Monique Fairweather, LMSW

  • Social Worker
  • Middletown, NY
  • NPI 1275829442
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1386155240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 LENOX PL",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109405526",
            "telephone_number": "347-512-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST STE 304",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404038",
            "telephone_number": "845-566-0286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPIST WITHOUT BORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "FAIRWEATHER",
        "authorized_official_first_name": "KELLY-ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-512-3636",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "083105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Middletown, NY
• Providers in Middletown, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.