Active NPI
Acanthus Nicole Fairley, LMSW
- Social Worker
- Brooklyn, NY
National Provider Identifier
1407208663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0906130
- Practice address
- 1334 Eastern Pkwy
Apt 2E
Brooklyn, NY 11233-5275 - Phone
- (631) 505-2563
- NPI assigned
- Jul 12, 2016
- Last updated
- Jul 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 0906130 | NY | Primary |
Addresses
Primary practice location
1334 Eastern Pkwy
Apt 2E
Brooklyn, NY 11233-5275
Mailing address
1334 Eastern Pkwy
Apt 2E
Brooklyn, NY 11233-5275
Phone (631) 505-2563
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 |
|---|---|---|---|
| 0906130 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468281600000",
"number": "1407208663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1334 EASTERN PKWY",
"address_2": "APT 2E",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112335275",
"telephone_number": "631-505-2563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1334 EASTERN PKWY",
"address_2": "APT 2E",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112335275",
"telephone_number": "631-505-2563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRLEY",
"first_name": "ACANTHUS",
"middle_name": "NICOLE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-12",
"last_updated": "2016-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "0906130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.