Active NPI
Brenda S Hartman-Souder, LCSW
- Clinical Social Worker
- Syracuse, NY
National Provider Identifier
1376889493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R042111-1
- Practice address
- 526 Oak St.
Syracuse, NY 13203 - Phone
- (315) 870-0154
- NPI assigned
- Dec 18, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R042111-1 | NY | Primary |
Addresses
Primary practice location
526 Oak St.
Syracuse, NY 13203
Mailing address
526 Oak St
Syracuse, NY 13203-1649
Phone (315) 870-0154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 9, 2021 through Nov 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R042111-1 | NY | MD | Clinical Social Worker |
| 042111 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362700800000",
"number": "1376889493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "526 OAK ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132031649",
"telephone_number": "315-870-0154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "526 OAK ST.",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13203",
"telephone_number": "315-870-0154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTMAN-SOUDER",
"first_name": "BRENDA",
"middle_name": "S",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-18",
"last_updated": "2013-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R042111-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.