Active NPI
Pablo Fernando Guevara, L.C.S.W.
- Clinical Social Worker
- Patchogue, NY
National Provider Identifier
1457618712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 074255-1
- Practice address
- 19 N Ocean Ave
Patchogue, NY 11772-2001 - Phone
- (631) 475-8641
- NPI assigned
- Apr 11, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 074255-1 | NY | Primary |
Addresses
Primary practice location
19 N Ocean Ave
Patchogue, NY 11772-2001
Mailing address
19 N Ocean Ave
Patchogue, NY 11772-2001
Phone (631) 475-8641
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 |
|---|---|---|---|
| 074255-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1457618712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 N OCEAN AVE",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722001",
"telephone_number": "631-475-8641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 N OCEAN AVE",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722001",
"telephone_number": "631-475-8641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUEVARA",
"first_name": "PABLO",
"middle_name": "FERNANDO",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-11",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "074255-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.