Richard Michael Prussin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PR014595-1 Issued in NY

Practice address

12 W Genesee St
Baldwinsville, NY 13027-1105

Phone

(315) 638-0988

Fax

(315) 251-2603

NPI assigned

Sep 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383264000000",
    "number": "1972605475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 W GENESEE ST",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130271105",
            "telephone_number": "315-638-0988",
            "fax_number": "315-251-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W GENESEE ST",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130271105",
            "telephone_number": "315-638-0988",
            "fax_number": "315-251-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUSSIN",
        "first_name": "RICHARD",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2013-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PR014595-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11239539",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "392979",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "146679",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward Felix Pospiech, PA
• Amy Potrzeba
• Premier Medical Equipment, LLC
• Tracey Prokop, CCC/SLP
• Jessica Pruitt
• Nicole Marie Quatrone
• Melissa Raab, LMFT
• Michael J Raab, LMHC
• Danielle Nicole Ranalli, PHARM, D.
• Matthew Rausch, DMD

• Clinical Social Worker in Baldwinsville, NY
• Providers in Baldwinsville, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.