Active NPI
Susan Gail Zola, LCSW
- Clinical Social Worker
- Melville, NY
National Provider Identifier
1043718240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 078530
- Practice address
- 276 Altessa Blvd.
Melville, NY 11747-5239 - Phone
- (631) 332-2213
- NPI assigned
- Jan 23, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 078530 | Primary |
Addresses
Primary practice location
276 Altessa Blvd.
Melville, NY 11747-5239
Mailing address
276 Altessa Blvd.
Melville, NY 11747-5239
Phone (631) 332-2213
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110738 | Other | TX | TEXAS LICENSING BOARD |
| LCSW-21778 | Other | AZ | ARIZONA LICENSING BOARD |
| SW19387 | Other | FL | FLORIDA LICENSING BOARD |
| 078530-01 | Other | NY | NEW YORK STATE LICENSING BOARD |
| 0904015623 | Other | VA | VIRGINIA LICENSING BOARD |
| LC22505 | Other | ME | MAINE LICENSING BOARD |
| 3045 | Other | NH | NEW HAMPSHIRE LICENSING BOARD |
| LICSW126256 | Other | MA | MASSACHUSETTS LICENSING BOARD |
| 012822 | Other | CT | CONNECTICUT LICENSING BOARD |
| 2021-3584 | Other | CSAT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 16, 2024 through Apr 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110738 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715212800000",
"number": "1043718240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "276 ALTESSA BLVD.",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117475239",
"telephone_number": "631-332-2213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "276 ALTESSA BLVD.",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117475239",
"telephone_number": "631-332-2213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZOLA",
"first_name": "SUSAN",
"middle_name": "GAIL",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-23",
"last_updated": "2024-05-09",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "078530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS LICENSING BOARD",
"identifier": "110738",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARIZONA LICENSING BOARD",
"identifier": "LCSW-21778",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA LICENSING BOARD",
"identifier": "SW19387",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE LICENSING BOARD",
"identifier": "078530-01",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA LICENSING BOARD",
"identifier": "0904015623",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINE LICENSING BOARD",
"identifier": "LC22505",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW HAMPSHIRE LICENSING BOARD",
"identifier": "3045",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSACHUSETTS LICENSING BOARD",
"identifier": "LICSW126256",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICUT LICENSING BOARD",
"identifier": "012822",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSAT",
"identifier": "2021-3584",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.