Individual provider Active NPI

Bonnie G Weintraub, CSW

  • Clinical Social Worker
  • Massapequa, NY
National Provider Identifier
1437299690
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R032557-1 Issued in NY
Practice address
627 Broadway
Ste.200
Massapequa, NY 11758-5031
Phone
(516) 221-4354
Fax
(516) 221-4354
NPI assigned
Feb 7, 2007
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
Clinical Social Worker 1041C0700X R032557-1 NY Primary

Addresses

Primary practice location

627 Broadway
Ste.200
Massapequa, NY 11758-5031

Mailing address

3610 Summer Dr
Wantagh, NY 11793-2780
Phone (516) 679-5878

Other identifiers 2

IdentifierTypeStateIssuer
7402636OtherNYBEHAVIORAL HEALTH PROVIDE
P75993OtherNYBEHAVIORAL HEALTH PROVIDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R032557-1NYMDClinical Social Worker
032557NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437299690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 SUMMER DR",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932780",
            "telephone_number": "516-679-5878",
            "fax_number": "516-679-5878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 BROADWAY",
            "address_2": "STE.200",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585031",
            "telephone_number": "516-221-4354",
            "fax_number": "516-221-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINTRAUB",
        "first_name": "BONNIE",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "CSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R032557-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIORAL HEALTH PROVIDE",
            "identifier": "7402636",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIORAL HEALTH PROVIDE",
            "identifier": "P75993",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.