Individual provider Active NPI

Lemlem Egziabher, LCSW

  • Clinical Social Worker
  • Holyoke, MA
National Provider Identifier
1255592739
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
001385 Issued in CT
Practice address
40 Bobala Rd
Holyoke, MA 01040-9632
Phone
(413) 536-5473
NPI assigned
Jun 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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 001385 CT Primary

Addresses

Primary practice location

40 Bobala Rd
Holyoke, MA 01040-9632

Mailing address

16 W Point Rd
East Hampton, CT 06424-1004
Phone (413) 536-5473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: No
  • 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
I20080722000406 CT Practitioner - Clinical Social Worker 7517030745 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001385CTMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sunrise Psychological Services LLC CurrentSince Jan 15, 2019 Accepting new patients
Mental Health Specialty Group PA CurrentSince May 1, 2025 Accepting new patients

Locations

385 Main St
Cromwell, CT 06416
Phone (860) 635-5613

100 Pearl St
Hartford, CT 06103
Phone (860) 969-1463

55 Grand St
New Britain, CT 06052
Phone (845) 459-5767

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

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": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1255592739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 W POINT RD",
            "city": "EAST HAMPTON",
            "state": "CT",
            "postal_code": "064241004",
            "telephone_number": "413-536-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 BOBALA RD",
            "city": "HOLYOKE",
            "state": "MA",
            "postal_code": "010409632",
            "telephone_number": "413-536-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGZIABHER",
        "first_name": "LEMLEM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "001385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holyoke, MA

Sources for this page

Verify at the official NPI Registry.