Active NPI
Peter G Depasquale, PHD MSW
- Social Worker
- Port Jefferson, NY
National Provider Identifier
1285782615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 29895
- Practice address
- 646 Main Street
Port Jefferson, NY 11777 - Phone
- (631) 689-8180
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 29895 | NY | Primary |
Addresses
Primary practice location
646 Main Street
Port Jefferson, NY 11777
Mailing address
27 Brewster Hill Road
Setauket, NY 11733
Phone (631) 689-8180
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120319000281 | NY | Practitioner - Clinical Social Worker | 7618136201 | Practice locations: Port Jefferson, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- State University of New York at Stony Brook, School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
27 Brewster Hill Rd
Setauket, NY 11733-1442
646 Main St
Port Jefferson, NY 11777-2235
Phone (631) 689-8180
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29895 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285782615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 BREWSTER HILL ROAD",
"city": "SETAUKET",
"state": "NY",
"postal_code": "11733",
"telephone_number": "631-689-8180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "646 MAIN STREET",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "11777",
"telephone_number": "631-689-8180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPASQUALE",
"first_name": "PETER",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "PHD MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "29895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.