Active NPI
Laura Jeanne Syvertson, LCSW
- Clinical Social Worker
- Ithaca, NY
National Provider Identifier
1295088979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 097203-01
- Practice address
- 319 N Tioga
Ithaca, NY 14850 - Phone
- (607) 220-7319
- NPI assigned
- Oct 18, 2012
- 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 | 097203-01 | NY | Primary |
Addresses
Primary practice location
319 N Tioga
Ithaca, NY 14850
Mailing address
409 Elm St
Ithaca, NY 14850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 097203-01 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759449600000",
"number": "1295088979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 ELM ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 N TIOGA",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850",
"telephone_number": "607-220-7319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SYVERTSON",
"first_name": "LAURA",
"middle_name": "JEANNE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-18",
"last_updated": "2025-10-03",
"certification_date": "2025-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "097203-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.