Individual provider Active NPI

Gianna L Ruddock, LCSW

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1063847291
Registry record updated Sep 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
079119-1 Issued in NY
Practice address
1293 E 46TH St
2ND Floor
Brooklyn, NY 11234-2001
Phone
(718) 288-8746
NPI assigned
Sep 6, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2013

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 079119-1 NY Primary

Addresses

Primary practice location

1293 E 46TH St
2ND Floor
Brooklyn, NY 11234-2001

Mailing address

1293 E 46TH St
2ND Floor
Brooklyn, NY 11234-2001
Phone (718) 288-8746

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
I20210623002501 NY Practitioner - Clinical Social Worker 1153722509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Queens Psychotherapy LCSW Services P.C.Group PAC ID 9931499639, 14 clinicians

Practice addresses (Care Compare)

9520 63Rd Rd
Suite J
Rego Park, NY 11374-1145
Phone 718459122518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
079119-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Queens Psychotherapy LCSW Services P.C. Clinical CurrentSince May 1, 2021 Accepting new patients

Locations

9520 63rd Rd
Ste J
Rego Park, NY 11374
Phone (718) 459-5812

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": "1378425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378425600000",
    "number": "1063847291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1293 E 46TH ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342001",
            "telephone_number": "718-288-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1293 E 46TH ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342001",
            "telephone_number": "718-288-8746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDOCK",
        "first_name": "GIANNA",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-06",
        "last_updated": "2013-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079119-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.