Individual provider Active NPI

Regina Savarese

  • Clinical Social Worker
  • Holtsville, NY
National Provider Identifier
1174038004
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
088804-01 Issued in NY
Practice address
750 Waverly Ave
Holtsville, NY 11742-1108
Phone
(631) 622-1200
NPI assigned
Dec 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 090320 NY
Clinical Social Worker 1041C0700X 088804-01 NY Primary

Addresses

Primary practice location

750 Waverly Ave
Holtsville, NY 11742-1108

Mailing address

63 1St St
Bayport, NY 11705-1329

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
090320NYMDSocial Worker
088804-01NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1513209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1174038004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 1ST ST",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WAVERLY AVE",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421108",
            "telephone_number": "631-622-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAVARESE",
        "first_name": "REGINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-14",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "090320",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "088804-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holtsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.