Gina Vincenza Peacock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00082746 Issued in NY

Practice address

3043 State Route 4
Hudson Falls, NY 12839-9632

Phone

(518) 747-2284

Fax

(518) 747-2253

NPI assigned

May 3, 2011

Last updated

Mar 26, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1164714606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3043 STATE ROUTE 4",
            "city": "HUDSON FALLS",
            "state": "NY",
            "postal_code": "128399632",
            "telephone_number": "518-747-2284",
            "fax_number": "518-747-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3043 STATE ROUTE 4",
            "city": "HUDSON FALLS",
            "state": "NY",
            "postal_code": "128399632",
            "telephone_number": "518-747-2284",
            "fax_number": "518-747-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "GINA",
        "middle_name": "VINCENZA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "00082239",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "00082746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00082746",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00082239",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Mallory Nicholson, MD
• Kevin T. Norris, R.PH.
• Elisha Lynn Novak, L.P.N.
• Patricia Ann Nunez, RN
• Laura Lyn Parrish-Combs, LMHC
• Patricia Lynn Peltier, L.P.N
• Jessica Percetti
• Kari Lynne Peters, LPN
• Paul Stephen Piotrowski, LCSW
• Christina Porter, LPN

• Clinical Social Worker in Hudson Falls, NY
• Providers in Hudson Falls, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.

Verify at the official NPI Registry.