Individual provider Active NPI

Judith Bellomo, LCSW

  • Social Worker
  • Lake Worth, FL
National Provider Identifier
1194031567
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
SW14127 Issued in FL
Practice address
6418 Breckenridge Circle
Lake Worth, FL 33467
Phone
(516) 633-3412
Fax
(561) 766-2189
NPI assigned
Aug 24, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 SW14127 FL Primary
Community/Behavioral Health Agency 251S00000X 2071410-1 NY

Addresses

Primary practice location

6418 Breckenridge Circle
Lake Worth, FL 33467

Mailing address

6418 Breckenridge Circle
Lake Worth, FL 33467
Phone (516) 633-3412

Other identifiers 1

IdentifierTypeStateIssuer
00393339MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20180220001984 FL Practitioner - Clinical Social Worker 4981885407 Reassigns benefits to 4 organizations
Practice locations: Lake Worth, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Different Like Me IncGroup PAC ID 0840385753, 10 clinicians

Practice addresses (Care Compare)

1601 Clint Moore Rd
Suite 120
Boca Raton, FL 33487-5712
Phone (561) 270-2280

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2071410-1NYMDCommunity/Behavioral Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Different Like Me Inc CurrentSince Jan 24, 2018 Accepting new patients
Cotler Healthcare & Development Inc. Community/Behavioral Health CurrentSince Feb 20, 2018 Accepting new patients
Mtca Psychological Services P.a. CurrentSince Feb 4, 2018 Accepting new patients
Cotler Children and Family Services, LLC CurrentSince Feb 20, 2018 Accepting new patients

Locations

1601 Clint Moore Rd
Ste 120
Boca Raton, FL 33487
Phone (561) 270-2280

7091 Atlantic Ave
Delray Beach, FL 33446
Phone (561) 558-2149

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

8461 Lake Worth Rd
Ste 250
Lake Worth, FL 33467

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

16853 NE 2nd Ave
Ste S304
North Miami Beach, FL 33162

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194031567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6418 BRECKENRIDGE CIRCLE",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33467",
            "telephone_number": "516-633-3412",
            "fax_number": "561-766-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6418 BRECKENRIDGE CIRCLE",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33467",
            "telephone_number": "516-633-3412",
            "fax_number": "561-766-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLOMO",
        "first_name": "JUDITH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW14127",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "2071410-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00393339",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

Verify at the official NPI Registry.