Active NPI
Donnetta Stallings, LCSW
- Social Worker
- Bronx, NY
National Provider Identifier
1396072013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 098200
- Practice address
- 2604 3Rd Ave
Bronx, NY 10454-1117 - Phone
- (646) 393-9680
- Fax
- (646) 393-9678
- NPI assigned
- Nov 17, 2009
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 098200 | NY | Primary |
Addresses
Primary practice location
2604 3Rd Ave
Bronx, NY 10454-1117
Mailing address
13720 231St St
Laurelton, NY 11413-2831
Phone (718) 978-0335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250602002012 | NY | Order and Referring Only - Clinical Social Worker | 8426567439 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 098200 | NY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical Providers PC | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1538894050
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747008000000",
"number": "1396072013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13720 231ST ST",
"city": "LAURELTON",
"state": "NY",
"postal_code": "114132831",
"telephone_number": "718-978-0335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 3RD AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104541117",
"telephone_number": "646-393-9680",
"fax_number": "646-393-9678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALLINGS",
"first_name": "DONNETTA",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-17",
"last_updated": "2025-05-12",
"certification_date": "2025-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "098200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.