Jill Berger, LCSW
Individual provider Active NPI Social Worker · Massapequa, NY
NPI 1366056632 · NPPES record last updated Aug 2, 2024
Key facts
- NPI
- 1366056632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 097446 (NY)
- Practice address
- 727 N Broadway Ste C1
Massapequa, NY 11758-2348 - Phone
- (516) 405-0503
- NPI assigned
- Sep 3, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210401000993 | NY | Practitioner - Clinical Social Worker | 8022425347 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 097446 | NY | MD | Social Worker |
| 110065 | NY | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goodman & D'Aconti, Lcsws PLLC | Current |
Accepting new patients |
Locations
727 N Broadway
Ste C1
Massapequa, NY 11758
Phone (516) 243-7909
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 097446 | NY | Yes |
Addresses
Primary practice location
727 N Broadway Ste C1
Massapequa, NY 11758-2348
Mailing address
496 Larch LN
East Meadow, NY 11554-3729
Phone (516) 474-8753
Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.