Individual provider Active NPI

Janice Earle, LCSW

  • Social Worker
  • Staten Island, NY
National Provider Identifier
1417989054
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
R030999 Issued in NY
Practice address
1534 Victory Blvd
Staten Island, NY 10314-3529
Phone
(718) 981-3026
Fax
(718) 983-0348
NPI assigned
Jul 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 R030999 NY Primary

Addresses

Primary practice location

1534 Victory Blvd
Staten Island, NY 10314-3529

Mailing address

415 Tarrytown Ave
Staten Island, NY 10306-4526
Phone (718) 979-7198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161205000464 NY Practitioner - Clinical Social Worker 8729368089 Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

148 Jacques Ave
Staten Island, NY 10306-3028
Phone (917) 439-7920

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R030999NYMDSocial Worker
030999NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Christa Durkin, LCSW, P.C. 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417989054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 TARRYTOWN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064526",
            "telephone_number": "718-979-7198",
            "fax_number": "718-983-0348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1534 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143529",
            "telephone_number": "718-981-3026",
            "fax_number": "718-983-0348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARLE",
        "first_name": "JANICE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "R030999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.