Active NPI
John Robert Klenchik, LMSW
- Social Worker
- Ithaca, NY
National Provider Identifier
1124711536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 086820
- Practice address
- 418 N Tioga St
Ithaca, NY 14850-5293 - Phone
- (607) 427-3939
- NPI assigned
- May 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | 086820 | NY | Primary |
Addresses
Primary practice location
418 N Tioga St
Ithaca, NY 14850-5293
Mailing address
11 Kentucky Ave
Trumansburg, NY 14886-9527
Phone (607) 427-3939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 086820 | Other | NY | LICENSED MASTER SOCIAL WORKER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 086820 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685491200000",
"number": "1124711536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 KENTUCKY AVE",
"city": "TRUMANSBURG",
"state": "NY",
"postal_code": "148869527",
"telephone_number": "607-427-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 N TIOGA ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148505293",
"telephone_number": "607-427-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLENCHIK",
"first_name": "JOHN",
"middle_name": "ROBERT",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-31",
"last_updated": "2023-05-31",
"certification_date": "2023-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "086820",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MASTER SOCIAL WORKER",
"identifier": "086820",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.