Active NPI
Carrie Dawn Nussbaumgrant, LMSW
- Social Worker
- Staten Island, NY
National Provider Identifier
1114523347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 08923401
- Practice address
- 402 Manor Rd # B
Staten Island, NY 10314-2959 - Phone
- (917) 770-0698
- NPI assigned
- Dec 11, 2020
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 08923401 | NY | Primary |
Addresses
Primary practice location
402 Manor Rd # B
Staten Island, NY 10314-2959
Mailing address
402 Manor Rd # B
Staten Island, NY 10314-2959
Phone (917) 770-0698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08923401 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1114523347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 MANOR RD # B",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103142959",
"telephone_number": "917-770-0698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 MANOR RD # B",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103142959",
"telephone_number": "917-770-0698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUSSBAUMGRANT",
"first_name": "CARRIE",
"middle_name": "DAWN",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-11",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "08923401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.