Juan C Olmedo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

080639 Issued in NY

Practice address

412 W 25TH St Apt 1B
New York, NY 10001-6542

Phone

(646) 449-0491

NPI assigned

Mar 23, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 8, 2023 through Dec 8, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Nunzio Signorella, LLC

  • Addiction (Substance Use Disorder) Counselor
  • New York, NY
  • NPI 1497121271

  Clinical

  NPD (past)

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1013158914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 MADISON AVE APT 3I",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165434",
            "telephone_number": "646-696-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W 25TH ST APT 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016542",
            "telephone_number": "646-449-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLMEDO",
        "first_name": "JUAN",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-23",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "72078317",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL BOARD FOR CERTIFICATION OF GROUP PSYCHOTHERAPISTS",
            "identifier": "058306",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OFFICE OF THE PROFESSIONS",
            "identifier": "080639",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OFFICE OF THE PROFESSIONS",
            "identifier": "72078317",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helen Suguitan Oller, M.D.
• Ermira Olli
• Anna Marie Ollinger, MS, CCC-SLP, TSSLD
• Mark Ollinger
• Maria I Olmeda-Jenkins, M.A., CCC-A
• Ruben Olmedo, MD
• Olo Acupuncture, PLLC
• Olom Home Care, Inc.
• Mehdi Mohammed Oloomi, MD
• Tosin Olowu, OT

• Clinical Social Worker in New York, NY
• Providers in New York, 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 Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.