NPIMap

Organization Active NPI

Queens Psychotherapy LCSW Services P.C.

  • Clinical Social Worker
  • Rego Park, NY
National Provider Identifier
1366806705
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
QUEENS PSYCHOTHERAPY LCSW SERVICES P.C.
Practice address
9520 63Rd Rd
Suite J
Rego Park, NY 11374-1160
Phone
(718) 459-1225
Fax
(718) 459-5805
NPI assigned
Apr 12, 2016
Last updated
Apr 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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

Authorized official

Name
Vanessa Acevedo, LCSW-RNPI 1134180136
Title
President
Phone
(718) 459-1225

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
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

9520 63Rd Rd
Suite J
Rego Park, NY 11374-1160

Mailing address

9520 63Rd Rd
Suite J
Rego Park, NY 11374-1160
Phone (718) 459-1225

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160608002581 NY Part B Supplier - Clinic/Group Practice 9931499639 Receives reassigned benefits from 31 practitioners
Practice locations: Rego Park, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460419200000",
    "number": "1366806705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9520 63RD RD",
            "address_2": "SUITE J",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741160",
            "telephone_number": "718-459-1225",
            "fax_number": "718-459-5805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9520 63RD RD",
            "address_2": "SUITE J",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741160",
            "telephone_number": "718-459-1225",
            "fax_number": "718-459-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS PSYCHOTHERAPY LCSW SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "last_updated": "2016-04-12",
        "status": "A",
        "authorized_official_last_name": "ACEVEDO",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-459-1225",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.