Active NPI
Nancy R Goldstein, LCSW-R
- Clinical Social Worker
- East Setauket, NY
National Provider Identifier
1497816771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R-031744-1
- Practice address
- 12 Deering St
East Setauket, NY 11733-3909 - Phone
- (631) 941-4704
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R-031744-1 | NY | Primary |
Addresses
Primary practice location
12 Deering St
East Setauket, NY 11733-3909
Mailing address
12 Deering St
East Setauket, NY 11733-3909
Phone (631) 941-4704
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R-031744-1 | Other | NY | SOCIAL WORK LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 10, 2023 through May 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-031744-1 | NY | MD | Clinical Social Worker |
| 031744 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497816771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 DEERING ST",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117333909",
"telephone_number": "631-941-4704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 DEERING ST",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117333909",
"telephone_number": "631-941-4704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSTEIN",
"first_name": "NANCY",
"middle_name": "R",
"name_prefix": "Ms.",
"credential": "LCSW-R",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R-031744-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL WORK LICENSE",
"identifier": "R-031744-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.