Individual provider Active NPI

Kimberly Nicole Vasquez Panchana, LCSW

  • Clinical Social Worker
  • Bronx, NY
National Provider Identifier
1205351160
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
100382 Issued in NY
Practice address
2739 3Rd Ave
Bronx, NY 10451-5801
Phone
(718) 992-7669
NPI assigned
Aug 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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 102533 NY
Clinical Social Worker 1041C0700X 100382 NY Primary

Addresses

Primary practice location

2739 3Rd Ave
Bronx, NY 10451-5801

Mailing address

1276 Fulton Ave
Bronx, NY 10456-3467
Phone (718) 992-7669

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
I20250801003093 NY Practitioner - Clinical Social Worker 6709394687 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102533NYMDSocial Worker
100382NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System CurrentSince Jun 13, 2025 Accepting new patients
Bronxcare Health System Current Accepting new patients
Bronxcare Health System Clinical CurrentSince Jun 13, 2025 Accepting new patients
Service Program for Older People, Inc PastSince Jul 6, 2009 Accepting new patients
Service Program for Older People Past Accepting new patients

Locations

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

1276 Fulton Ave
Bronx, NY 10456
Phone (718) 518-5000

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1205351160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563467",
            "telephone_number": "718-992-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2739 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515801",
            "telephone_number": "718-992-7669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ PANCHANA",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-11",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "102533",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "100382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.