Active NPI
Malycia Jarrett Gordon
- Social Worker
- Smithtown, NY
National Provider Identifier
1497539415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 118 Fifty Acre Rd S
Smithtown, NY 11787-2035 - Phone
- (347) 228-2789
- NPI assigned
- Aug 21, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 107708 | NY | |
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
118 Fifty Acre Rd S
Smithtown, NY 11787-2035
Mailing address
118 Fifty Acre Rd S
Smithtown, NY 11787-2035
Phone (347) 228-2789
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 |
|---|---|---|---|
| 107708 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692835200000",
"number": "1497539415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 FIFTY ACRE RD S",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872035",
"telephone_number": "347-228-2789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 FIFTY ACRE RD S",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872035",
"telephone_number": "347-228-2789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARRETT GORDON",
"first_name": "MALYCIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-21",
"last_updated": "2023-08-24",
"certification_date": "2023-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "107708",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.