Individual provider Active NPI

Debbie Gross, LCSW-R

  • Clinical Social Worker
  • Coram, NY
National Provider Identifier
1043646995
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
076337-1 Issued in NY
Practice address
4 Otter Path
Coram, NY 11727-2148
Phone
(516) 764-5522
Fax
(516) 764-0154
NPI assigned
Sep 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 076337-1 NY Primary

Addresses

Primary practice location

4 Otter Path
Coram, NY 11727-2148

Mailing address

137 Broadway Ste D2
Amityville, NY 11701-2731
Phone (516) 721-6212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190506000588 FL Practitioner - Clinical Social Worker 5991095929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychiatric Specialty Center, LLCGroup PAC ID 2961702089, 20 clinicians

Practice addresses (Care Compare)

1035 S State Rd
7 Suite 209
Wellington, FL 33414-6136
Phone (561) 331-8800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
076337-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatric Specialty Center LLC CurrentSince Sep 1, 2024 Accepting new patients
Mindpath Health Florida, PLLC Clinical PastSince Sep 1, 2024 Accepting new patients

Locations

1035 S State Road 7
Ste 209
Wellington, FL 33414
Phone (561) 331-8800

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": "1379980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1043646995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 BROADWAY STE D2",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012731",
            "telephone_number": "516-721-6212",
            "fax_number": "631-828-8216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 OTTER PATH",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117272148",
            "telephone_number": "516-764-5522",
            "fax_number": "516-764-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "DEBBIE",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-24",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "076337-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

Verify at the official NPI Registry.