NPIMap

Individual provider Active NPI

Michelle Mormino

  • Addiction (Substance Use Disorder) Counselor
  • New York, NY
National Provider Identifier
1619375003
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
27320 Issued in NY
Practice address
19 Union SQ W
Floor 7
New York, NY 10003-3304
Phone
(212) 627-9600
NPI assigned
Dec 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 27320 NY Primary

Addresses

Primary practice location

19 Union SQ W
Floor 7
New York, NY 10003-3304

Mailing address

19 Union SQ W
Floor 7
New York, NY 10003-3304
Phone (212) 627-9600

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

LicenseStateTypeSpecialty
27320NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Realization Center Past Accepting new patients
Realization Center, Inc. PastSince Sep 1, 2015 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1619375003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 UNION SQ W",
            "address_2": "FLOOR 7",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100033304",
            "telephone_number": "212-627-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 UNION SQ W",
            "address_2": "FLOOR 7",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100033304",
            "telephone_number": "212-627-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORMINO",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "27320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.