Active NPI
Jacob M Gorman, LMSW
- Clinical Social Worker
- Owego, NY
National Provider Identifier
1699009779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 079843
- Practice address
- 1062 State Route 38
Owego, NY 13827 - Phone
- (607) 687-4000
- Fax
- (607) 687-6396
- NPI assigned
- Sep 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 | 079843 | NY | Primary |
Addresses
Primary practice location
1062 State Route 38
Owego, NY 13827
Mailing address
1062 State Route 38
PO Box 177
Owego, NY 13827
Phone (607) 687-4000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00618162 | Other | NY | GROUP MEDICAID NUMBER |
| 39062A | Other | NY | GROUP MEDICARE NUMBER |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253664000000",
"number": "1699009779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1062 STATE ROUTE 38",
"address_2": "PO BOX 177",
"city": "OWEGO",
"state": "NY",
"postal_code": "13827",
"telephone_number": "607-687-4000",
"fax_number": "607-687-6396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1062 STATE ROUTE 38",
"city": "OWEGO",
"state": "NY",
"postal_code": "13827",
"telephone_number": "607-687-4000",
"fax_number": "607-687-6396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORMAN",
"first_name": "JACOB",
"middle_name": "M",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-23",
"last_updated": "2009-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "079843",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAID NUMBER",
"identifier": "00618162",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE NUMBER",
"identifier": "39062A",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Owego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.