Individual provider Active NPI

Rebecca Perez, LCSW-R

  • Social Worker
  • Ozone Park, NY
National Provider Identifier
1083825186
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
00059166 Issued in NY
Practice address
108-19 Rockaway Blvd
Ozone Park, NY 11420
Phone
(718) 845-2620
Fax
(718) 845-9380
NPI assigned
May 24, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 00059166 NY Primary

Addresses

Primary practice location

108-19 Rockaway Blvd
Ozone Park, NY 11420

Mailing address

108-19 Rockaway Blvd
Ozone Park, NY 11420
Phone (718) 845-2620

Other identifiers 1

IdentifierTypeStateIssuer
00059166MedicaidNY

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
I20041103001275 NY Practitioner - Clinical Social Worker 6204898976 Practice locations: Brooklyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2829 Ocean Pkwy
Suite 2
Brooklyn, NY 11235-7859
Phone (917) 373-0546

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00059166NYMDSocial Worker
059166NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ab Medical Care PLLC Past Accepting new patients
Steinway Child and Family Services, Inc Past Accepting new patients
Steinway Child and Family Services, Inc. Past Accepting new patients
Petrychenko Physician PC Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083825186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108-19 ROCKAWAY BLVD",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11420",
            "telephone_number": "718-845-2620",
            "fax_number": "718-845-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108-19 ROCKAWAY BLVD",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11420",
            "telephone_number": "718-845-2620",
            "fax_number": "718-845-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "REBECCA",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "00059166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00059166",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozone Park, NY

Sources for this page

Verify at the official NPI Registry.