Individual provider Active NPI

Debra Jean Washington, LCSW

  • Clinical Social Worker
  • Elmhurst, NY
National Provider Identifier
1225353931
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
090115-01 Issued in NY
Practice address
9131 Queens Blvd Ste 222
Elmhurst, NY 11373-5511
Phone
(718) 896-3400
Fax
(718) 459-5621
NPI assigned
Apr 6, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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 090115-01 NY Primary

Addresses

Primary practice location

9131 Queens Blvd Ste 222
Elmhurst, NY 11373-5511

Mailing address

17520 Wexford Ter Apt 4U
Jamaica, NY 11432-2838
Phone (718) 593-0794

Other identifiers 1

IdentifierTypeStateIssuer
00244019MedicaidNY

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
I20201215003166 NY Practitioner - Clinical Social Worker 0042622003 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
090115-01NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Long Island Consultation Center CurrentSince Aug 15, 2021 Accepting new patients
Long Island Consultation Center, Inc. Clinical CurrentSince Sep 10, 2020 Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Locations

9131 Queens Blvd
Ste 222
Elmhurst, NY 11373
Phone (718) 896-3400

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/liccnewyorkcity/r4/

Organizations & group practices 3

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": "1270512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1225353931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17520 WEXFORD TER APT 4U",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114322838",
            "telephone_number": "718-593-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD STE 222",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735511",
            "telephone_number": "718-896-3400",
            "fax_number": "718-459-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "DEBRA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-06",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "090115-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.