Individual provider Active NPI

Betty Lynn Gannon, LCSW

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1306312236
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
099537 Issued in NY
Practice address
134 N 4TH St
Brooklyn, NY 11249-3296
Phone
(646) 450-7748
NPI assigned
Oct 18, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 099537 NY Primary
Clinical Social Worker 1041C0700X 089.0137083 VT
Clinical Social Worker 1041C0700X 15443 CT

Addresses

Primary practice location

134 N 4TH St
Brooklyn, NY 11249-3296

Mailing address

445 Smith Ridge Rd
South Salem, NY 10590-2626
Phone (203) 216-2832

Other names 1

  • Betty Gannon Other name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250423000843 NY Practitioner - Clinical Social Worker 4082139902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valera Medical PCGroup PAC ID 0547690521, 160 clinicians

Practice addresses (Care Compare)

134 N 4TH St
Brooklyn, NY 11249-3296
Phone (646) 450-7748

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15443CTMDClinical Social Worker
089.0137083VTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Valera Medical, P.C. Social Worker CurrentSince Feb 15, 2025 Accepting new patients

Locations

134 N 4th St
Brooklyn, NY 11249

139 Centre St
Ste 824
New York, NY 10013
Phone (646) 450-7751

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1539820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1306312236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 SMITH RIDGE RD",
            "city": "SOUTH SALEM",
            "state": "NY",
            "postal_code": "105902626",
            "telephone_number": "203-216-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 N 4TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112493296",
            "telephone_number": "646-450-7748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "BETTY LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-18",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "099537",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0137083",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "15443",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETTY",
            "last_name": "GANNON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.