NPIMap

Organization Active NPI

South Towns Wellness LCSW PLLC

  • Clinical Social Worker
  • Hamburg, NY
National Provider Identifier
1487032702
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SOUTH TOWNS WELLNESS LCSW PLLC
Practice address
162 Main St
Hamburg, NY 14075-4917
Phone
(716) 325-0006
NPI assigned
May 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Authorized official

Name
Kathleen Kubera, LCSW-R
Title
Member
Phone
(716) 325-0006

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

162 Main St
Hamburg, NY 14075-4917

Mailing address

188 Long Ave
Hamburg, NY 14075-6211
Phone (716) 220-4224

Other identifiers 1

IdentifierTypeStateIssuer
04126945MedicaidNY

National Provider Directory

National Provider Directory

Locations

162 Main St
Hamburg, NY 14075
Phone (716) 325-0006

34 E Main St
Hamburg, NY 14075

4535 Southwestern Blvd
Ste 205B
Hamburg, NY 14075
Phone (716) 866-4422

5820 Main St
Ste 204
Williamsville, NY 14221
Phone (716) 634-2538

Practitioners & affiliated clinicians

Practitioners 8

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": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1487032702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 LONG AVE",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140756211",
            "telephone_number": "716-220-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 MAIN ST",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140754917",
            "telephone_number": "716-325-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TOWNS WELLNESS LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "KUBERA",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "716-325-0006",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04126945",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamburg, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; 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.