Active NPI
Alphonso Mitchum, LCSW
- Clinical Social Worker
- Albany, NY
National Provider Identifier
1598859092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 069423-1
- Practice address
- 113 Holland Ave
Albany, NY 12208-3410 - Phone
- (518) 626-5162
- Fax
- (518) 462-3099
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 28, 2008
- 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 | 069423-1 | NY | Primary |
Addresses
Primary practice location
113 Holland Ave
Albany, NY 12208-3410
Mailing address
350 Clinton Avenue
Albany, NY 12206
Phone (518) 626-5317
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 069423-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1598859092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 CLINTON AVENUE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12206",
"telephone_number": "518-626-5317",
"fax_number": "518-626-5407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 HOLLAND AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122083410",
"telephone_number": "518-626-5162",
"fax_number": "518-462-3099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHUM",
"first_name": "ALPHONSO",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "069423-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.