NPIMap

Organization Active NPI

Senior Living Behavioral Health LCSW PLLC

  • Clinical Social Worker
  • New York, NY
National Provider Identifier
1083150056
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SENIOR LIVING BEHAVIORAL HEALTH LCSW PLLC
Practice address
747 3Rd Ave
2ND Floor
New York, NY 10017-2803
Phone
(800) 829-0115
NPI assigned
Jan 13, 2017
Last updated
Jan 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Authorized official

Name
Bruce Brotter, PHD
Title
Sole MBR
Phone
(800) 829-0115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NY Primary

Addresses

Primary practice location

747 3Rd Ave
2ND Floor
New York, NY 10017-2803

Mailing address

747 3Rd Ave
2ND Floor
New York, NY 10017-2803
Phone (800) 829-0115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, PA, CT, FL5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20170213000455 NY Part B Supplier - Clinic/Group Practice 9931482247 Receives reassigned benefits from 58 practitioners
Practice locations: Lynbrook, NY; Niskayuna, NY; Sayville, NY; Slingerlands, NY; South Setauket, NY; Syracuse, NY; West Seneca, NY; Westbury, NY…
O20181120000165 NJ Part B Supplier - Clinic/Group Practice 9931482247 Receives reassigned benefits from 6 practitioners
Practice locations: New York, NY
O20200601000154 PA Part B Supplier - Clinic/Group Practice 9931482247 Receives reassigned benefits from 5 practitioners
Practice locations: Harleysville, PA; Media, PA
O20200630003355 CT Part B Supplier - Clinic/Group Practice 9931482247 Receives reassigned benefits from 11 practitioners
Practice locations: Brooklyn, CT; Farmington, CT; Litchfield, CT; Newtown, CT
O20210413001827 FL Part B Supplier - Clinic/Group Practice 9931482247 Receives reassigned benefits from 2 practitioners
Practice locations: Tamarac, FL

National Provider Directory

National Provider Directory

Locations

40 Merrick Ave
Ste 1
East Meadow, NY 11554
Phone (516) 542-0800

400 W 63rd St
New York, NY 10069

747 3rd Ave
Fl 2
New York, NY 10017
Phone (516) 387-2375

3030 Clinton St
West Seneca, NY 14224
Phone (716) 822-4466

Practitioners & affiliated clinicians

Practitioners 98

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1083150056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 3RD AVE",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100172803",
            "telephone_number": "800-829-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 3RD AVE",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100172803",
            "telephone_number": "800-829-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR LIVING BEHAVIORAL HEALTH LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "BROTTER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "800-829-0115",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.