Individual provider Active NPI

Leeann Diedrick, LCSW

  • Clinical Social Worker
  • Hicksville, NY
National Provider Identifier
1063451599
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
073395-1 Issued in NY
Practice address
950 S Oyster Bay Rd
Hicksville, NY 11801-3510
Phone
(516) 822-6111
Fax
(516) 342-2496
NPI assigned
Jun 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 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 073395-1 NY Primary

Addresses

Primary practice location

950 S Oyster Bay Rd
Hicksville, NY 11801-3510

Mailing address

950 S Oyster Bay Rd
Hicksville, NY 11801-3510
Phone (516) 822-6111

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
I20060608000147 NY Practitioner - Clinical Social Worker 8921010075 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
073395-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Central Nassau Guidance & Counseling Services, Inc. Clinical CurrentSince Aug 26, 2017 Accepting new patients

Locations

950 S Oyster Bay Rd
Hicksville, NY 11801

Organizations & group practices 1

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1063451599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S OYSTER BAY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118013510",
            "telephone_number": "516-822-6111",
            "fax_number": "516-342-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 S OYSTER BAY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118013510",
            "telephone_number": "516-822-6111",
            "fax_number": "516-342-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDRICK",
        "first_name": "LEEANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "073395-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

Verify at the official NPI Registry.