Active NPI
Tracey F Kunkin, L.M.S.W.
- Clinical Social Worker
- Staten Island, NY
National Provider Identifier
1265656326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 066954-1
- Practice address
- 3974 Amboy Rd
3Rd FL
Staten Island, NY 10308-2414 - Phone
- (718) 984-5050
- Fax
- (718) 984-5165
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 066954-1 | NY | Primary |
Addresses
Primary practice location
3974 Amboy Rd
3Rd FL
Staten Island, NY 10308-2414
Mailing address
161 14TH St
#2
Hoboken, NJ 07030-4417
Phone (201) 240-6780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 24, 2017 through May 24, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 066954-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265656326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 14TH ST",
"address_2": "#2",
"city": "HOBOKEN",
"state": "NJ",
"postal_code": "070304417",
"telephone_number": "201-240-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3974 AMBOY RD",
"address_2": "3RD FL",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103082414",
"telephone_number": "718-984-5050",
"fax_number": "718-984-5165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNKIN",
"first_name": "TRACEY",
"middle_name": "F",
"credential": "L.M.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "066954-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.