Essentia Telehealth Wellness, LCSW, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ESSENTIA TELEHEALTH WELLNESS, LCSW, PLLC

Practice address

110 Mechanic St
Fayetteville, NY 13066-1333

Phone

(505) 365-1519

NPI assigned

Sep 5, 2024

Organization subpart

No

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

Authorized official

Name

Enrique Antonio Rosario, LCSW-RNPI 1053467753

Title

Co-Owner

Phone

(505) 365-1519

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Enrique Antonio Rosario, LCSW-R

  • Clinical Social Worker
  • Syracuse, NY
  • NPI 1053467753

  Clinical, NY

  Medicare reassignment NPD Authorized official
• Nicole Elizabeth Lovass-Nagy

  • Clinical Social Worker
  • Malone, NY
  • NPI 1366966590

  Clinical, NY

  Medicare reassignment NPD

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1184459448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MECHANIC ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661333",
            "telephone_number": "505-365-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MECHANIC ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661333",
            "telephone_number": "505-365-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIA TELEHEALTH WELLNESS, LCSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "ROSARIO",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "505-365-1519",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alissa Easterly, PTA
• Eastside Audiology Services, LLC
• Janet Eatman, M.A., CCC-SLP
• Errol S McKenzie MD PLLC
• Essentia Telehealth and Wellness
• Marlee Anne Fallon, PA-C
• Family Medical Care of Dewitt PLLC
• Sara Lou Farchione, MD
• Fateh Supply Inc
• Fayetteville Dental Associates

• All providers in Fayetteville, NY
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.