NPIMap

Organization Active NPI

Mobile Counseling of New York LCSW, PLLC

  • Clinical Social Worker
  • Grand Island, NY
National Provider Identifier
1700359700
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MOBILE COUNSELING OF NEW YORK LCSW, PLLC
Practice address
52 Woodstream Dr
Grand Island, NY 14072-1485
Phone
(716) 302-4545
NPI assigned
Jan 2, 2019
Last updated
Mar 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Authorized official

Name
Nino Elizondo, LCSW-RNPI 1164608188
Title
Owner
Phone
(716) 302-4545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

52 Woodstream Dr
Grand Island, NY 14072-1485

Mailing address

52 Woodstream Dr
Grand Island, NY 14072-1485
Phone (716) 302-4545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210513001278 NY Part B Supplier - Clinic/Group Practice 9234548710 Receives reassigned benefits from 3 practitioners
Practice locations: Grand Island, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1700359700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 WOODSTREAM DR",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140721485",
            "telephone_number": "716-302-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 WOODSTREAM DR",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140721485",
            "telephone_number": "716-302-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE COUNSELING OF NEW YORK LCSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-02",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "ELIZONDO",
        "authorized_official_first_name": "NINO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-302-4545",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.