Ellen Goodman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

024669 Issued in NY

Practice address

9729 64TH Rd
Rego Park, NY 11374-2240

Phone

(718) 896-3400

Fax

(718) 459-5621

NPI assigned

Jan 4, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ellen Imhof Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/liccnewyorkcity/r4/

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.

• Long Island Consultation Center

  • Counselor
  • Elmhurst, NY
  • NPI 1356016703
  NPD (past)

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1366627747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 2ND AVE",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110503126",
            "telephone_number": "516-474-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9729 64TH RD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742240",
            "telephone_number": "718-896-3400",
            "fax_number": "718-459-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "ELLEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-04",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "024669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "IMHOF",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Barbara Laura Goldstein, P.T.
• Gary Golduber, MD
• Rita Goldvug, M.D
• Nasir Mahmood Gondal, MD
• Lissette B Gonzalez, M.S.
• Krystal-Ann Gopichand
• Jessica Nicole Gordon
• Maryann Gorman, RD
• Christopher Gozun, DDS
• Maria Supnet Gozun, DDS

• Clinical Social Worker in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.