Jennifer Perciavalle, LCSW, CASAC-G

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

087638 Issued in NY

Practice address

155 Indian Head Rd
Commack, NY 11725

Phone

(631) 543-6200

NPI assigned

Dec 8, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Catholic Charities of the Diocese of Rockville Centre

  • Community/Behavioral Health Agency
  • Hampton Bays, NY
  • NPI 1164555140
  NPD (past)

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555286400000",
    "number": "1265677066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 INDIAN HEAD RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252298",
            "telephone_number": "631-543-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 INDIAN HEAD RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "11725",
            "telephone_number": "631-543-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 E Montauk Hwy",
            "address_purpose": "LOCATION",
            "city": "Hampton Bays",
            "state": "NY",
            "postal_code": "119461816",
            "country_code": "US",
            "telephone_number": "631-723-3362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERCIAVALLE",
        "first_name": "JENNIFER",
        "credential": "LCSW, CASAC-G",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-08",
        "last_updated": "2019-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "28504",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "087638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Pulmonary Medicine PC
• Pegasus Physical Therapy, P.C.
• Digna Maricela Pena-Hollwedel, MS
• Alexandra Marte Penalver
• Miriam Lee Pennise, NP
• Eleanor Frankel Perlman, LCSW, DCSW, BCD
• Ann Marie Perrino, NP
• Debra Michele Perron, PTA
• Lisa Perryfink
• Andrew Persaud, LMHC

• Clinical Social Worker in Commack, NY
• Providers in Commack, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.