Individual provider Active NPI

Susan Rachael Palmich, LCSW R

  • Clinical Social Worker
  • Huntington, NY
National Provider Identifier
1174880561
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
073838-1 Issued in NY
Practice address
775 Park Ave
Suite 255
Huntington, NY 11743-3976
Phone
(631) 697-2644
Fax
(631) 421-0631
NPI assigned
Apr 23, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 073838-1 NY Primary

Addresses

Primary practice location

775 Park Ave
Suite 255
Huntington, NY 11743-3976

Mailing address

775 Park Ave
Suite 255
Huntington, NY 11743-3976
Phone (631) 697-2644

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

LicenseStateTypeSpecialty
073838-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1174880561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 PARK AVE",
            "address_2": "SUITE 255",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117433976",
            "telephone_number": "631-697-2644",
            "fax_number": "631-421-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 PARK AVE",
            "address_2": "SUITE 255",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117433976",
            "telephone_number": "631-697-2644",
            "fax_number": "631-421-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMICH",
        "first_name": "SUSAN",
        "middle_name": "RACHAEL",
        "name_prefix": "Mrs.",
        "credential": "LCSW R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "073838-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.