NPIMap

Organization Active NPI

Long Island Consultation Center, Inc.

  • Clinical Social Worker
  • Elmhurst, NY
National Provider Identifier
1295878577
Registry record updated Nov 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6715100A Issued in NY
Legal business name
LONG ISLAND CONSULTATION CENTER, INC.
Practice address
9131 Queens Blvd Ste 222
Elmhurst, NY 11373-5511
Phone
(718) 896-3400
Fax
(718) 459-5621
NPI assigned
Feb 15, 2007
Last updated
Nov 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2016

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

Authorized official

Name
Ms. Elaine Lederer, LCSWNPI 1205909983
Title
Executive Director
Phone
(718) 896-3400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 090210852 NY
Clinical Social Worker 1041C0700X 6715100A NY Primary

Addresses

Primary practice location

9131 Queens Blvd Ste 222
Elmhurst, NY 11373-5511

Mailing address

9131 Queens Blvd Ste 222
Elmhurst, NY 11373-5511
Phone (718) 896-3400

Other identifiers 1

IdentifierTypeStateIssuer
00244019MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721001568 NY Part B Supplier - Clinic/Group Practice 8729068622 Receives reassigned benefits from 49 practitioners
Practice locations: Elmhurst, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 140

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 140

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1295878577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD STE 222",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735511",
            "telephone_number": "718-896-3400",
            "fax_number": "718-459-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD STE 222",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735511",
            "telephone_number": "718-896-3400",
            "fax_number": "718-459-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND CONSULTATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "LEDERER",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-896-3400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "090210852",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "6715100A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.