Active NPI
Dorothy L Distel, LCSW-R
- Clinical Social Worker
- Newburgh, NY
National Provider Identifier
1063579068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R036529-1
- Practice address
- 141 Broadway
Newburgh, NY 12550 - Phone
- (845) 568-5260
- Fax
- (845) 568-5213
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- No
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 | R036529-1 | NY | Primary |
Addresses
Primary practice location
141 Broadway
Newburgh, NY 12550
Mailing address
141 Broadway
Newburgh, NY 12550
Phone (845) 568-5260
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00542503 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R036529-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343865600000",
"number": "1063579068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 BROADWAY",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "12550",
"telephone_number": "845-568-5260",
"fax_number": "845-568-5213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 BROADWAY",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "12550",
"telephone_number": "845-568-5260",
"fax_number": "845-568-5213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTEL",
"first_name": "DOROTHY",
"middle_name": "L",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2012-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R036529-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00542503",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.