Carol Marcia Potruch, LCSW, PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R040274-1 Issued in NY

Practice address

1527 Franklin Ave
Suite 203
Mineola, NY 11501-4827

Phone

(516) 317-1493

Fax

(212) 744-0696

NPI assigned

Oct 27, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003992611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E 67TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100216255",
            "telephone_number": "516-317-1493",
            "fax_number": "212-744-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 FRANKLIN AVE",
            "address_2": "SUITE 203",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014827",
            "telephone_number": "516-317-1493",
            "fax_number": "212-744-0696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTRUCH",
        "first_name": "CAROL",
        "middle_name": "MARCIA",
        "name_prefix": "Dr.",
        "credential": "LCSW, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R040274-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Purnima Popli, M.D.
• Heather A Posillico, DO
• Nicole Posillico
• Shannon L Postiglione
• Renee Potashner, MD
• Jayne Potter, LCSW
• James Vanarsdale Potts, DO
• Shannon Poulose, MD
• Anthony Powers
• Megan Beatrice Powers, PA-C

• Clinical Social Worker in Mineola, NY
• Providers in Mineola, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.