Individual provider Active NPI

Jessica Lauren Tannenbaum, LCSW

  • Social Worker
  • Commack, NY
National Provider Identifier
1417569252
Registry record updated May 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
106511 Issued in NY
Practice address
6500 Jericho Tpke Ste 217
Commack, NY 11725-2907
Phone
(516) 298-5981
NPI assigned
Aug 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 106511 NY Primary

Addresses

Primary practice location

6500 Jericho Tpke Ste 217
Commack, NY 11725-2907

Mailing address

6500 Jericho Turnpike Suite 217
Commack, NY 11725
Phone (631) 543-8877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106511NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Solutions Counseling LCSW PLLC PastSince May 14, 2023 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.

NPI Registry JSON

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

{
    "created_epoch": "1598054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683417600000",
    "number": "1417569252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 JERICHO TURNPIKE SUITE 217",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "11725",
            "telephone_number": "631-543-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 JERICHO TPKE STE 217",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252907",
            "telephone_number": "516-298-5981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "JESSICA",
        "middle_name": "LAUREN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-22",
        "last_updated": "2023-05-07",
        "certification_date": "2023-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "106511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

Verify at the official NPI Registry.