Individual provider Active NPI

S. Leslie Annis, LCSW

  • Clinical Social Worker
  • Bayside, NY
National Provider Identifier
1194709519
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSWR 027552-1 Issued in NY
Practice address
2904 203Rd St
Bayside, NY 11360-2336
Phone
(718) 631-2748
Fax
(718) 732-2880
NPI assigned
Nov 30, 2005
Last updated
Jun 18, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

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 LCSWR 027552-1 NY Primary

Addresses

Primary practice location

2904 203Rd St
Bayside, NY 11360-2336

Mailing address

2904 203Rd St
Bayside, NY 11360-2336
Phone (718) 361-2748

Other identifiers 1

IdentifierTypeStateIssuer
01988105MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070221000227 NY Practitioner - Clinical Social Worker 4587766621 Practice locations: Bayside, NY
I20251009000858 FL Practitioner - Clinical Social Worker 4587766621 Practice locations: Winter Park, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1813 Gipson Green LN
Winter Park, FL 32789-1482
Phone (718) 631-2748

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSWR 027552-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1194709519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 203RD ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113602336",
            "telephone_number": "718-361-2748",
            "fax_number": "718-732-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 203RD ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113602336",
            "telephone_number": "718-631-2748",
            "fax_number": "718-732-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANNIS",
        "first_name": "S.",
        "middle_name": "LESLIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "LCSWR 027552-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01988105",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.