Active NPI
Ellen Deweerdt, LCSW
- Social Worker
- West Islip, NY
National Provider Identifier
1508078106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0364981
- Practice address
- 400 Montauk Highway
Suite 114
West Islip, NY 11795 - Phone
- (631) 321-1221
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 0364981 | NY | Primary |
Addresses
Primary practice location
400 Montauk Highway
Suite 114
West Islip, NY 11795
Mailing address
9 Oak Road
Huntington, NY 11743-1955
Phone (631) 385-8734
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090304000280 | NY | Practitioner - Clinical Social Worker | 0840356598 | Practice locations: Huntington, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
9 Oak Rd
Huntington, NY 11743-1955
Phone (516) 551-0403
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0364981 | NY | MD | Social Worker |
| 036498 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508078106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 OAK ROAD",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117431955",
"telephone_number": "631-385-8734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 MONTAUK HIGHWAY",
"address_2": "SUITE 114",
"city": "WEST ISLIP",
"state": "NY",
"postal_code": "11795",
"telephone_number": "631-321-1221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWEERDT",
"first_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "0364981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Islip, 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; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.