Active NPI
Anne Rodriguez, L.C.S.W.
- Clinical Social Worker
- Riverhead, NY
National Provider Identifier
1508922063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P046121
- Practice address
- 220 Roanoke Ave
Riverhead, NY 11901-2755 - Phone
- (631) 506-0284
- Fax
- (631) 506-0285
- NPI assigned
- Dec 29, 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 | P046121 | NY | Primary |
Addresses
Primary practice location
220 Roanoke Ave
Riverhead, NY 11901-2755
Mailing address
PO Box 119
Aquebogue, NY 11931-0119
Phone (631) 779-3416
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02426391 | Medicaid | NY |
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 |
|---|---|---|---|---|
| I20060327000381 | NY | Practitioner - Clinical Social Worker | 5092723478 | Practice locations: Riverhead, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P046121 | NY | MD | Clinical Social Worker |
| 046121 | NY | MD | Physical Therapist |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508922063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 119",
"city": "AQUEBOGUE",
"state": "NY",
"postal_code": "119310119",
"telephone_number": "631-779-3416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 ROANOKE AVE",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012755",
"telephone_number": "631-506-0284",
"fax_number": "631-506-0285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "ANNE",
"name_prefix": "Ms.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "P046121",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02426391",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Riverhead, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.