Individual provider Active NPI

Lourdes G. Lacolla, LCSW

  • Clinical Social Worker
  • Bellmore, NY
National Provider Identifier
1104867977
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R051905 Issued in NY
Practice address
220 Pettit Ave
Bellmore, NY 11710-3629
Phone
(516) 233-8758
NPI assigned
Jun 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 R051905 NY Primary

Addresses

Primary practice location

220 Pettit Ave
Bellmore, NY 11710-3629

Mailing address

2911 Lindale St
Wantagh, NY 11793-2310
Phone (516) 785-2883

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
I20060614000151 NY Practitioner - Clinical Social Worker 3971515875 Practice locations: Massapequa, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R051905NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104867977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 LINDALE ST",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932310",
            "telephone_number": "516-785-2883",
            "fax_number": "516-783-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 PETTIT AVE",
            "city": "BELLMORE",
            "state": "NY",
            "postal_code": "117103629",
            "telephone_number": "516-233-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACOLLA",
        "first_name": "LOURDES",
        "middle_name": "G.",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R051905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellmore, NY

Sources for this page

Verify at the official NPI Registry.