Organization Active NPI

Family Care Counseling Services, LCSW,P.C.

  • Clinical Social Worker
  • Miller Place, NY
National Provider Identifier
1467578575
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R040232 Issued in NY
Legal business name
FAMILY CARE COUNSELING SERVICES, LCSW,P.C.
Practice address
595 Route 25a Ste 20
Miller Place, NY 11764-2647
Phone
(631) 744-5500
Fax
(631) 744-5677
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

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

Authorized official

Name
Mrs. Kathleen Anne Van Essendelft, L-RCSW
Title
Director
Phone
(631) 744-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X R040232 NY Primary

Addresses

Primary practice location

595 Route 25a Ste 20
Miller Place, NY 11764-2647

Mailing address

595 Route 25a Ste 20
Miller Place, NY 11764-2647
Phone (631) 744-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080730000840 NY Part B Supplier - Clinic/Group Practice 2365516986 Receives reassigned benefits from 1 practitioner
Practice locations: Miller Place, NY

National Provider Directory

National Provider Directory

Locations

595 Route 25A
Ste 20
Miller Place, NY 11764
Phone (631) 744-5500

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1467578575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 ROUTE 25A STE 20",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117642647",
            "telephone_number": "631-744-5500",
            "fax_number": "631-744-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 ROUTE 25A STE 20",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117642647",
            "telephone_number": "631-744-5500",
            "fax_number": "631-744-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE COUNSELING SERVICES, LCSW,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "VAN ESSENDELFT",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "631-744-5500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "L-RCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R040232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miller Place, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.