Colleen Marian Myrie, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL06562900 Issued in NJ

Practice address

25 Clifton Ave Apt D1812
Newark, NJ 07104-1855

Phone

(917) 224-2691

NPI assigned

May 1, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1497376388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CLIFTON AVE APT D1812",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071041855",
            "telephone_number": "917-224-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CLIFTON AVE APT D1812",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071041855",
            "telephone_number": "917-224-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYRIE",
        "first_name": "COLLEEN",
        "middle_name": "MARIAN",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-01",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06562900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD LICENSE",
            "identifier": "44SL06562900",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://rchc.rutgers.edu/",
            "affiliation": "Y",
            "affiliationName": "Rutgers Nursing Faculty Practice",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "449 Broad Street",
            "city": "Newark",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "07102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Social Worker in Newark, NJ
• Providers in Newark, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.