Active NPI
Matthew Charles Mancuso, MSW, LMSW
- Clinical Social Worker
- Bay Pines, FL
National Provider Identifier
1780171140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12529
- Practice address
- 10000 Bay Pines Blvd
Bay Pines, FL 33744-8200 - Phone
- (727) 398-6661
- NPI assigned
- Apr 20, 2018
- 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 | 12529 | SC | Primary |
Addresses
Primary practice location
10000 Bay Pines Blvd
Bay Pines, FL 33744-8200
Mailing address
4936 Miramar Dr Unit 4205
Madeira Beach, FL 33708-3397
Phone (845) 641-2254
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 |
|---|---|---|---|
| 12529 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- matthewmancuso@tdh.allscriptsdirect.net
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": "1524182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524182400000",
"number": "1780171140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4936 MIRAMAR DR UNIT 4205",
"city": "MADEIRA BEACH",
"state": "FL",
"postal_code": "337083397",
"telephone_number": "845-641-2254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10000 BAY PINES BLVD",
"city": "BAY PINES",
"state": "FL",
"postal_code": "337448200",
"telephone_number": "727-398-6661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANCUSO",
"first_name": "MATTHEW",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MSW, LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-20",
"last_updated": "2018-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "SC",
"license": "12529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.