Active NPI
Brennen Riddick
- Social Worker
- Elmira, NY
National Provider Identifier
1649501974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 096797
- Practice address
- 1019 E Water St
Elmira, NY 14901-3332 - Phone
- (607) 733-5696
- NPI assigned
- Jan 27, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Social Worker | 104100000X | 096797 | NY | Primary |
Addresses
Primary practice location
1019 E Water St
Elmira, NY 14901-3332
Mailing address
1019 E Water St
Elmira, NY 14901-3332
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 |
|---|---|---|---|
| 096797 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465430400000",
"number": "1649501974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 E WATER ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149013332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1019 E WATER ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149013332",
"telephone_number": "607-733-5696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDICK",
"first_name": "BRENNEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-27",
"last_updated": "2016-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "096797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.