Active NPI
Ivy Firouztale
- Clinical Social Worker
- Dix Hills, NY
National Provider Identifier
1144620089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 078295-1
- Practice address
- 2 Pudding LN
Dix Hills, NY 11746-6118 - Phone
- (631) 432-8424
- NPI assigned
- Aug 28, 2014
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 078295-1 | NY | Primary |
Addresses
Primary practice location
2 Pudding LN
Dix Hills, NY 11746-6118
Mailing address
2 Pudding LN
Dix Hills, NY 11746-6118
Phone (631) 432-8424
Other names 1
- Ivy Closky
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 26, 2022 through Jan 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 078295-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1144620089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 PUDDING LN",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117466118",
"telephone_number": "631-432-8424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 PUDDING LN",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117466118",
"telephone_number": "631-432-8424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIROUZTALE",
"first_name": "IVY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-28",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "078295-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "IVY",
"last_name": "CLOSKY",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Dix Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.