Active NPI
Jennifer Renee Vardaro, LCSW
- Clinical Social Worker
- Lynbrook, NY
National Provider Identifier
1255699716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 083414
- Practice address
- 68 Merrick Rd # B
Lynbrook, NY 11563-2756 - Phone
- (516) 296-0480
- NPI assigned
- May 2, 2012
- Last updated
- Apr 15, 2016
- 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 | 083414 | NY | Primary |
Addresses
Primary practice location
68 Merrick Rd # B
Lynbrook, NY 11563-2756
Mailing address
68 Merrick Rd # B
Lynbrook, NY 11563-2756
Phone (516) 296-0480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 27, 2021 through Jul 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083414 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460678400000",
"number": "1255699716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 MERRICK RD # B",
"city": "LYNBROOK",
"state": "NY",
"postal_code": "115632756",
"telephone_number": "516-296-0480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 MERRICK RD # B",
"city": "LYNBROOK",
"state": "NY",
"postal_code": "115632756",
"telephone_number": "516-296-0480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARDARO",
"first_name": "JENNIFER",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-02",
"last_updated": "2016-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "083414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynbrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; 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.