Individual provider Active NPI

Brandon Tosov, LCSW

  • Clinical Social Worker
  • Smithtown, NY
National Provider Identifier
1427426253
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
090959 Issued in NY
Practice address
24 Bellemeade Ave Ste 24-102
Smithtown, NY 11787-1855
Phone
(631) 317-4079
NPI assigned
Sep 10, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Social Worker 104100000X 099048-1 NY
Clinical Social Worker 1041C0700X 090959 NY Primary

Addresses

Primary practice location

24 Bellemeade Ave Ste 24-102
Smithtown, NY 11787-1855

Mailing address

865 Broadway Ave Apt 201B
Holbrook, NY 11741-4946
Phone (631) 317-4079

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
I20220822000120 NY Practitioner - Clinical Social Worker 2769865922 Practice locations: Smithtown, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
State University of New York at Stony Brook, School of Medicine, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

24 Bellemeade Ave
Suite 24 102
Smithtown, NY 11787-1855
Phone (631) 317-4079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
099048-1NYMDSocial Worker

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

NPI Registry JSON

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

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1427426253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 BROADWAY AVE APT 201B",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414946",
            "telephone_number": "631-317-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 BELLEMEADE AVE STE 24-102",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871855",
            "telephone_number": "631-317-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOSOV",
        "first_name": "BRANDON",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-10",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "099048-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "090959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

Verify at the official NPI Registry.