Individual provider Active NPI

Carolyn Anne Nussbaum, LCSW

  • Social Worker
  • Elmhurst, NY
National Provider Identifier
1013088509
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
R50896 Issued in NY
Practice address
80TH St & 41St Ave
Elmhurst, NY 11373-1329
Phone
(718) 334-3900
Fax
(718) 334-5958
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X R50896 NY Primary

Addresses

Primary practice location

80TH St & 41St Ave
Elmhurst, NY 11373-1329

Mailing address

7901 Broadway
Managed Care, D1-01
Elmhurst, NY 11373-1329
Phone (718) 334-1921

Other identifiers 1

IdentifierTypeStateIssuer
00246075MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20260327004015 NY Practitioner - Clinical Social Worker 8921583881 Reassigns benefits to 1 organization
I20260401002471 NJ Practitioner - Clinical Social Worker 8921583881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6603 Fresh Pond Rd
Ridgewood, NY 11385-3310

835 Main St
Hackensack, NJ 07601-4812

PO Box
Suite 924
Maywood, NJ 07607

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R50896NYMDSocial Worker
050896NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bleuler Psychotherapy Center, Inc. PastSince Mar 10, 1999 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/bleulerpc/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013088509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 BROADWAY",
            "address_2": "MANAGED CARE, D1-01",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731329",
            "telephone_number": "718-334-1921",
            "fax_number": "718-334-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80TH ST & 41ST AVE",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731329",
            "telephone_number": "718-334-3900",
            "fax_number": "718-334-5958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSSBAUM",
        "first_name": "CAROLYN",
        "middle_name": "ANNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "R50896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.