Active NPI
Anthony Deriso
- Mental Health Counselor
- Huntersville, NC
National Provider Identifier
1801522065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 9620
- Practice address
- 8914 Lizzie LN
Huntersville, NC 28078-5614 - Phone
- (704) 560-6738
- NPI assigned
- Jul 28, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 1146772 | NC | |
| Mental Health Counselor | 101YM0800X | 9620 | NC | Primary |
Addresses
Primary practice location
8914 Lizzie LN
Huntersville, NC 28078-5614
Mailing address
8914 Lizzie LN
Huntersville, NC 28078-5614
Phone (704) 560-6738
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 |
|---|---|---|---|
| 9620 | NC | MD | Mental Health Counselor |
| 1146772 | NC | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658966400000",
"number": "1801522065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8914 LIZZIE LN",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280785614",
"telephone_number": "704-560-6738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8914 LIZZIE LN",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280785614",
"telephone_number": "704-560-6738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERISO",
"first_name": "ANTHONY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-28",
"last_updated": "2022-07-28",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "NC",
"license": "1146772",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "9620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.