NPIMap

Organization Active NPI

Heart & Soul Community Counseling

  • Clinical Social Worker
  • West Babylon, NY
National Provider Identifier
1346223252
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
HEART & SOUL COMMUNITY COUNSELING
Practice address
17 Fordham Rd
West Babylon, NY 11704-5803
Phone
(631) 321-7011
Fax
(631) 669-8532
NPI assigned
Nov 23, 2005
Last updated
May 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Authorized official

Name
Tina L CalabreseNPI 1497737860
Title
President / Executive Director
Phone
(631) 321-7011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

17 Fordham Rd
West Babylon, NY 11704-5803

Mailing address

17 Fordham Rd
West Babylon, NY 11704-5803
Phone (631) 321-7011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190521001824 NY Part B Supplier - Clinic/Group Practice 1951644657 Receives reassigned benefits from 10 practitioners
Practice locations: West Babylon, NY; East Quogue, NY; Wantagh, NY

National Provider Directory

National Provider Directory

Locations

429 Montauk Hwy
East Quogue, NY 11942
Phone (631) 321-7011

1400 Wantagh Ave
Ste L2
Wantagh, NY 11793
Phone (516) 559-0194

17 Fordham Rd
West Babylon, NY 11704
Phone (631) 321-7011

609 Route 109
Ste 1C
West Babylon, NY 11704
Phone (631) 321-7011

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1346223252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 FORDHAM RD",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117045803",
            "telephone_number": "631-321-7011",
            "fax_number": "631-669-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 FORDHAM RD",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117045803",
            "telephone_number": "631-321-7011",
            "fax_number": "631-669-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART & SOUL COMMUNITY COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "CALABRESE",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT / EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "631-321-7011"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Babylon, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.