Active NPI
Roxy A. Mico, LCSW
- Clinical Social Worker
- Hilo, HI
National Provider Identifier
1811380975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 3244
- Practice address
- 162 Kinoole St Ste 101
Hilo, HI 96720-2861 - Phone
- (808) 935-0070
- Fax
- (808) 935-0070
- NPI assigned
- Mar 13, 2015
- Sex
- Female
- 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 | LCSW 3244 | HI | Primary |
Addresses
Primary practice location
162 Kinoole St Ste 101
Hilo, HI 96720-2861
Mailing address
PO Box 10068
Hilo, HI 96721-5068
Phone (808) 935-0070
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H105719 | Other | HI | PTAN |
| 1275942591 | Other | HI | TYPE 2 NPI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 3244 | HI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1811380975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10068",
"city": "HILO",
"state": "HI",
"postal_code": "967215068",
"telephone_number": "808-935-0070",
"fax_number": "808-935-0070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 KINOOLE ST STE 101",
"city": "HILO",
"state": "HI",
"postal_code": "967202861",
"telephone_number": "808-935-0070",
"fax_number": "808-935-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICO",
"first_name": "ROXY",
"middle_name": "A.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-13",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "LCSW 3244",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "H105719",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TYPE 2 NPI",
"identifier": "1275942591",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.