Individual provider Active NPI

Alicia Yvette Henderson, LCSW, PH.D.

  • Clinical Social Worker
  • New York, NY
National Provider Identifier
1053565598
Registry record updated Nov 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R048309-1 Issued in NY
Practice address
160 W 86TH St
New York, NY 10024-4018
Phone
(212) 362-5730
NPI assigned
Nov 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2008

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 R048309-1 NY Primary

Addresses

Primary practice location

160 W 86TH St
New York, NY 10024-4018

Mailing address

160 West 86TH Street
New York, NY 10024
Phone (212) 362-5730

Other identifiers 1

IdentifierTypeStateIssuer
R048309-1OtherNYLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20090327000448 NY Practitioner - Clinical Social Worker 3779640271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

279 E 3Rd St
New York, NY 10009-7813
Phone (212) 531-7533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
R048309-1NYMDClinical Social Worker
048309NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
William F Ryan Community Health Center Inc CurrentSince Sep 1, 2022 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Oct 31, 2024 Accepting new patients
William F Ryan Community Health Center Inc Current Accepting new patients

Locations

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

110 W 97th St
#0
New York, NY 10025

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ryan Health Midtown Emotional Wellness CenterNew York, NY, CCN 571871 Federally qualified health center W-2 Managing Employee Sep 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226966400000",
    "number": "1053565598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 WEST 86TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10024",
            "telephone_number": "212-362-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 W 86TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100244018",
            "telephone_number": "212-362-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "ALICIA",
        "middle_name": "YVETTE",
        "name_prefix": "Dr.",
        "credential": "LCSW, PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-11",
        "last_updated": "2008-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R048309-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "R048309-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.