Georgia Koutouzis, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

101705 Issued in NY

Practice address

425 Old Town Rd FL 1
Port Jefferson Station, NY 11776-3627

Phone

(631) 209-7042

Fax

(631) 840-4780

NPI assigned

Oct 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mindful Therapy LCSW, PLLC

  • Clinical Social Worker
  • Commack, NY
  • NPI 1275014136
  Medicare reassignment NPD

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

{
    "created_epoch": "1508457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696118400000",
    "number": "1265943989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 OLD TOWN RD FL 1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763627",
            "telephone_number": "631-209-7042",
            "fax_number": "631-840-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 OLD TOWN RD FL 1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763627",
            "telephone_number": "631-209-7042",
            "fax_number": "631-840-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTOUZIS",
        "first_name": "GEORGIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-20",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "101705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Konopka
• Adam Joseph Korzenko, M.D.
• Meredith Marie Kosinski, TEACHER
• Danielle Kossack
• Emanuel Kostakos, PH.D.
• Carrie-Ann Kraft
• Kelly Krivit
• Bryan J Krivosta, PHARM D
• Lauren Nicole Krystall, CFY
• Arthur Samuel Kurtz, MD

• Social Worker in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.