Individual provider Active NPI

Rachel Sidebotham, LCSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1124620265
Registry record updated May 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
097995 Issued in NY
Practice address
1045 James St
Syracuse, NY 13203-2730
Phone
(585) 746-6211
NPI assigned
Nov 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X 110973-01 NY
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X
Clinical Social Worker 1041C0700X 097995 NY Primary

Addresses

Primary practice location

1045 James St
Syracuse, NY 13203-2730

Mailing address

1045 James St
Syracuse, NY 13203-2730

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
I20240726003704 NY Practitioner - Clinical Social Worker 3274079140 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valera Medical PCGroup PAC ID 0547690521, 160 clinicians

Practice addresses (Care Compare)

134 N 4TH St
Brooklyn, NY 11249-3296
Phone (646) 450-7748

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
110973-01NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Valera Medical, P.C. Social Worker CurrentSince May 5, 2025 Accepting new patients
Canino LCSW Psychotherapy PC Single Specialty CurrentSince Jul 1, 2024 Accepting new patients

Locations

134 N 4th St
Brooklyn, NY 11249

139 Centre St
Ste 824
New York, NY 10013
Phone (646) 450-7751

Organizations & group practices 2

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": "1605225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746316800000",
    "number": "1124620265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "585-746-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDEBOTHAM",
        "first_name": "RACHEL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-13",
        "last_updated": "2025-05-04",
        "certification_date": "2025-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NY",
            "license": "110973-01",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "097995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.