Individual provider Active NPI

Yazmik S Cantillano, LMSW

  • Clinical Social Worker
  • Benton Harbor, MI
National Provider Identifier
1649854308
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801116726 Issued in MI
Practice address
1485 M 139
Benton Harbor, MI 49022-5711
Phone
(269) 925-0585
Fax
(269) 927-1326
NPI assigned
May 10, 2021
Last updated
Jul 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801116726 MI Primary
Clinical Social Worker 1041C0700X 6801109483 MI
Clinical Social Worker 1041C0700X 6851109483 MI

Addresses

Primary practice location

1485 M 139
Benton Harbor, MI 49022-5711

Mailing address

1485 M 139
Benton Harbor, MI 49022-5711
Phone (269) 925-0585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20230721002002 MI Practitioner - Clinical Social Worker 4183084130 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Coach Psychology PLCGroup PAC ID 9133304744, 11 clinicians

Practice addresses (Care Compare)

300 W Ferry St
Berrien Springs, MI 49103-1109
Phone (269) 815-5331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801109483MIMDClinical Social Worker
6851109483MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Berrien Mental Health Authority CurrentSince Jul 6, 2023 Accepting new patients
Berrien Mental Health Authority CurrentSince Jul 6, 2023 Accepting new patients

Locations

1485 M 139
Benton Harbor, MI 49022
Phone (269) 934-1611

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1649854308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490225711",
            "telephone_number": "269-925-0585",
            "fax_number": "269-927-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490225711",
            "telephone_number": "269-925-0585",
            "fax_number": "269-927-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTILLANO",
        "first_name": "YAZMIK",
        "middle_name": "S",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-10",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801116726",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801109483",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851109483",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

Verify at the official NPI Registry.