Alissa Brooks, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

650 Hallock Ave
Port Jeff Sta, NY 11776-1256

Phone

(631) 403-3318

NPI assigned

Dec 11, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lighthouse Integrative Counseling Services LCSW Marriage and Family TH

  • Clinical Social Worker
  • Port Jefferson, NY
  • NPI 1699135566
  Medicare reassignment NPD

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1063008209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 S DORADO CIR APT 2G",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884634",
            "telephone_number": "585-797-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HALLOCK AVE",
            "city": "PORT JEFF STA",
            "state": "NY",
            "postal_code": "117761256",
            "telephone_number": "631-403-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "ALISSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christiana Kehinde Ayanfodun
• Graceann Elizabeth Baldenko
• Nicole Berry, OTR/L
• Michele Caren Boss, SPECIAL EDUCATION TE
• Jamie Lyn Brennan
• Garrett Buckner, BA, MA
• Valerie Ann Derzie
• Theresa Rose Domenichello, LCSW
• Angela Donadio, MA SPECIAL EDUCATOR
• Tim Edwards

• Social Worker in Port Jeff Sta, NY
• Providers in Port Jeff Sta, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.