Active NPI
Michaeleen McMahon Anderson, LCSW
- Clinical Social Worker
- Holbrook, NY
National Provider Identifier
1720157571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R045247-1
- Practice address
- 991 Main St
Suite 102
Holbrook, NY 11741-1608 - Phone
- (631) 981-4419
- Fax
- (631) 981-4419
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R045247-1 | NY | |
| Clinical Social Worker | 1041C0700X | R045247-1 | NY | Primary |
Addresses
Primary practice location
991 Main St
Suite 102
Holbrook, NY 11741-1608
Mailing address
991 Main St
Suite 102
Holbrook, NY 11741-1608
Phone (631) 981-4419
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 |
|---|---|---|---|
| R045247-1 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances T Soto-Valentino LCSW PC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1720157571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "991 MAIN ST",
"address_2": "SUITE 102",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "117411608",
"telephone_number": "631-981-4419",
"fax_number": "631-981-4419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "991 MAIN ST",
"address_2": "SUITE 102",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "117411608",
"telephone_number": "631-981-4419",
"fax_number": "631-981-4419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MICHAELEEN",
"middle_name": "MCMAHON",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-07",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "R045247-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R045247-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holbrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.