Individual provider Active NPI

Maryann V McInerney, LCSW

  • Clinical Social Worker
  • Bellport, NY
National Provider Identifier
1568533354
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
RO19618-1 Issued in NY
Practice address
15 Bellport LN
Suite 15D
Bellport, NY 11713-2751
Phone
(631) 286-4779
Fax
(631) 286-6323
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X RO19618-1 NY Primary

Addresses

Primary practice location

15 Bellport LN
Suite 15D
Bellport, NY 11713-2751

Mailing address

15 Bellport LN
Suite 15D
Bellport, NY 11713-2751
Phone (631) 286-4779

Other identifiers 5

IdentifierTypeStateIssuer
078943OtherNYVALUE OPTIONS
081336000OtherNYMAGELLAN
P2635131OtherNYOXFORD
028495OtherNYMANAGED HEALTH NETWORK
16506OtherNYVYTRA

Other names 1

  • Not Applicable Not Applicable Nnot Applicable Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061205000426 NY Practitioner - Clinical Social Worker 3678572401 Practice locations: Brookhaven, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

9 Brook Nursery Dr
Brookhaven, NY 11719-9754
Phone (631) 286-4779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RO19618-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1568533354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 BELLPORT LN",
            "address_2": "SUITE 15D",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132751",
            "telephone_number": "631-286-4779",
            "fax_number": "631-286-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 BELLPORT LN",
            "address_2": "SUITE 15D",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132751",
            "telephone_number": "631-286-4779",
            "fax_number": "631-286-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINERNEY",
        "first_name": "MARYANN",
        "middle_name": "V",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "RO19618-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "078943",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "081336000",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2635131",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH NETWORK",
            "identifier": "028495",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "16506",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NOT APPLICABLE",
            "last_name": "NNOT APPLICABLE",
            "middle_name": "NOT APPLICABLE",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bellport, NY

Sources for this page

Verify at the official NPI Registry.