Active NPI
Susan C Funicelli, LMSW
- Social Worker
- Ithaca, NY
National Provider Identifier
1508805383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0565391
- Practice address
- 201 East Green St
Ithaca, NY 14850 - Phone
- (607) 274-6200
- Fax
- (607) 274-6316
- NPI assigned
- Jun 6, 2006
- Last updated
- Jul 24, 2013
- 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 | 0565391 | NY | Primary |
Addresses
Primary practice location
201 East Green St
Ithaca, NY 14850
Mailing address
201 East Green St
Ithaca, NY 14850
Phone (607) 274-6200
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
| License | State | Type | Specialty |
|---|---|---|---|
| 0565391 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1508805383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 EAST GREEN ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850",
"telephone_number": "607-274-6200",
"fax_number": "607-274-6316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 EAST GREEN ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850",
"telephone_number": "607-274-6200",
"fax_number": "607-274-6316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNICELLI",
"first_name": "SUSAN",
"middle_name": "C",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-06",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "0565391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.