Individual provider Active NPI

Ashley Josara De Verteuil, LCSW

  • Clinical Social Worker
  • Long Island City, NY
National Provider Identifier
1306087440
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
091108 Issued in NY
Practice address
3300 Northern Blvd FL 5
Long Island City, NY 11101-2215
Phone
(646) 265-6237
NPI assigned
Mar 19, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 087991 NY
Clinical Social Worker 1041C0700X 091108 NY Primary

Addresses

Primary practice location

3300 Northern Blvd FL 5
Long Island City, NY 11101-2215

Mailing address

3300 Northern Blvd FL 5
Long Island City, NY 11101-2215

Other identifiers 1

IdentifierTypeStateIssuer
AP0814MedicaidNY

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
087991NYMDSocial Worker
091108NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1306087440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 NORTHERN BLVD FL 5",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 NORTHERN BLVD FL 5",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012215",
            "telephone_number": "646-265-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VERTEUIL",
        "first_name": "ASHLEY",
        "middle_name": "JOSARA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-19",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "087991",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "091108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AP0814",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; 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.