Active NPI
Irina Ivanova
- Clinical Social Worker
- Fair Lawn, NJ
National Provider Identifier
1902623903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SL07127800
- Practice address
- 13-20 River Rd # R
Fair Lawn, NJ 07410-1847 - Phone
- (201) 466-2725
- NPI assigned
- Sep 23, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SL07127800 | NJ | Primary |
Addresses
Primary practice location
13-20 River Rd # R
Fair Lawn, NJ 07410-1847
Mailing address
13-20 River Rd # R
Fair Lawn, NJ 07410-1847
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 |
|---|---|---|---|
| 44SL07127800 | NJ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1902623903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13-20 RIVER RD # R",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074101847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13-20 RIVER RD # R",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074101847",
"telephone_number": "201-466-2725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVANOVA",
"first_name": "IRINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-23",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SL07127800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Lawn, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.