Active NPI
Pamela Petkanas, L.C.S.W.
- Clinical Social Worker
- Putnam Valley, NY
National Provider Identifier
1225439144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 079994-01
- Practice address
- 306 Dennytown Rd
Putnam Valley, NY 10579-1423 - Phone
- (908) 230-8131
- NPI assigned
- Sep 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 079994-01 | NY | Primary |
Addresses
Primary practice location
306 Dennytown Rd
Putnam Valley, NY 10579-1423
Mailing address
306 Dennytown Rd
Putnam Valley, NY 10579-1423
Phone (908) 230-8131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 26, 2022 through Jan 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 079994-01 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1225439144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 DENNYTOWN RD",
"city": "PUTNAM VALLEY",
"state": "NY",
"postal_code": "105791423",
"telephone_number": "908-230-8131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 DENNYTOWN RD",
"city": "PUTNAM VALLEY",
"state": "NY",
"postal_code": "105791423",
"telephone_number": "908-230-8131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETKANAS",
"first_name": "PAMELA",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-10",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "079994-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam Valley, NY
- Frank Pellegrino, LCSW, CASAC
- Gina Marie Pepe, IBCLC
- Francesca Perez Haggan, LCSW
- Richard Andrew Peri, RN
- Gregory Perlman, LCSW
- Rick Martin Pezzullo, DPT
- Susan Mary Powers-Kulusic, LCSW
- Premier Medical Associates of the Hudson Valley
- Putnam Valley Central School District
- Putnam Valley Pediatrics, P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.