Guy Anthony Koutouvidis, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R052825-1 Issued in NY

Practice address

14 E Broadway
Suite 2
Port Jefferson, NY 11777-1400

Phone

(631) 642-9525

Fax

(631) 642-9525

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609941814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 OLIVIA DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117764470",
            "telephone_number": "631-474-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 E BROADWAY",
            "address_2": "SUITE 2",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771400",
            "telephone_number": "631-642-9525",
            "fax_number": "631-642-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTOUVIDIS",
        "first_name": "GUY",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R052825-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Kopec, AU.D.
• Anuja Korlipara, MD
• Julia Korobenko, DO
• Jeffrey Robert Kott, M.D.
• Richard E Koty, M.D.
• Dorothy Mary Kozlowski, NP
• Austin Kraft, CRNA
• Darabeth Kraniak
• Benjamin Krasnyanskiy
• Kristen Krawczyk, D.P.T

• Clinical Social Worker in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.