Active NPI
Mara J Brandon, LCSW, CASAC 2
- Clinical Social Worker
- New York, NY
National Provider Identifier
1891123907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 085699
- Practice address
- 310 W End Ave
New York, NY 10023-8146 - Phone
- (646) 632-5377
- Fax
- (212) 313-9419
- NPI assigned
- Oct 29, 2013
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 21232 | NY | |
| Social Worker | 104100000X | 084080 | NY | |
| Clinical Social Worker | 1041C0700X | 085699 | NY | Primary |
Addresses
Primary practice location
310 W End Ave
New York, NY 10023-8146
Mailing address
310 W End Ave
New York, NY 10023-8146
Phone (646) 632-5377
Other practice location 1
123 4th Ave
2nd Floor
New York, NY 10003-4935
Phone (646) 632-5377
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00695941 | Medicaid | NY | |
| 5631735 | Other | NY | CIGNA |
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 |
|---|---|---|---|
| 084080 | NY | MD | Social Worker |
| 085699 | NY | MD | Clinical Social Worker |
| 21232 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1891123907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 W END AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100238146",
"telephone_number": "646-632-5377",
"fax_number": "212-313-9419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W END AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100238146",
"telephone_number": "646-632-5377",
"fax_number": "212-313-9419"
}
],
"practiceLocations": [
{
"address_1": "123 4th Ave",
"address_2": "2nd Floor",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100034935",
"country_code": "US",
"telephone_number": "646-632-5377",
"fax_number": "212-313-9419",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRANDON",
"first_name": "MARA",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "LCSW, CASAC 2",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-29",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "21232",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "084080",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "085699",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00695941",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5631735",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.