Individual provider Active NPI

Laurie Cannon, LCSW

  • Clinical Social Worker
  • Seaford, NY
National Provider Identifier
1184737314
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
049571-1 Issued in NY
Practice address
2146 Jackson Ave
Seaford, NY 11783-2606
Phone
(516) 221-3030
Fax
(516) 221-4160
NPI assigned
Aug 15, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 049571-1 NY Primary

Addresses

Primary practice location

2146 Jackson Ave
Seaford, NY 11783-2606

Mailing address

2146 Jackson Ave
Seaford, NY 11783-2606
Phone (516) 221-3030

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110401000464 NY Practitioner - Clinical Social Worker 5092903559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
049571-1NYMDClinical Social Worker
049571NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184737314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2146 JACKSON AVE",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832606",
            "telephone_number": "516-221-3030",
            "fax_number": "516-221-4160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2146 JACKSON AVE",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832606",
            "telephone_number": "516-221-3030",
            "fax_number": "516-221-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "LAURIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "049571-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seaford, NY

Sources for this page

Verify at the official NPI Registry.