Individual provider Active NPI

Lauren Spodak, LCSW

  • Clinical Social Worker
  • Ridgewood, NJ
National Provider Identifier
1255717187
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05640100 Issued in NJ
Practice address
171E Ridgewood Ave
Ridgewood, NJ 07450-3865
Phone
(201) 759-0296
NPI assigned
Aug 3, 2015
Last updated
Oct 28, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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 44SC05640100 NJ Primary

Addresses

Primary practice location

171E Ridgewood Ave
Ridgewood, NJ 07450-3865

Mailing address

30-15 Gentner Rd
Fair Lawn, NJ 07410-4544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20151221000885 NJ Practitioner - Clinical Social Worker 8729389580 Practice locations: Ridgewood, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

216 Dayton St
Suite 3
Ridgewood, NJ 07450-4450
Phone (201) 759-0296

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1255717187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30-15 GENTNER RD",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171E RIDGEWOOD AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503865",
            "telephone_number": "201-759-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPODAK",
        "first_name": "LAUREN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-03",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05640100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.