Active NPI
Donald S. Cornelius, LCSW
- Clinical Social Worker
- Woodbury, NY
National Provider Identifier
1154525673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PR017761-1
- Practice address
- 136 Woodbury Rd
Suite 103
Woodbury, NY 11797-1411 - Phone
- (516) 692-4055
- NPI assigned
- Jun 11, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | PR017761-1 | NY | Primary |
Addresses
Primary practice location
136 Woodbury Rd
Suite 103
Woodbury, NY 11797-1411
Mailing address
9 Tall Oak Dr
Huntington, NY 11743-7115
Phone (631) 423-0773
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 |
|---|---|---|---|
| PR017761-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154525673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 TALL OAK DR",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117437115",
"telephone_number": "631-423-0773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 WOODBURY RD",
"address_2": "SUITE 103",
"city": "WOODBURY",
"state": "NY",
"postal_code": "117971411",
"telephone_number": "516-692-4055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELIUS",
"first_name": "DONALD",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "PR017761-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.