Tiffany Susan Zacholl, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

065549 Issued in NY

Practice address

526 Old Liverpool Rd
Liverpool, NY 13088-6238

Phone

(315) 453-3911

Fax

(315) 453-0197

NPI assigned

Jul 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tiffany Susan Pelkey Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glenville, NY
  • NPI 1336339969
  NPD (past)
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215475200000",
    "number": "1528221876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31094",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061501094",
            "telephone_number": "518-952-8140",
            "fax_number": "518-952-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 OLD LIVERPOOL RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886238",
            "telephone_number": "315-453-3911",
            "fax_number": "315-453-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACHOLL",
        "first_name": "TIFFANY",
        "middle_name": "SUSAN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2008-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "065549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01420800",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "PELKEY",
            "middle_name": "SUSAN",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurie C Yehle, L.M.T
• Yost Corporation
• Dana Zaborowski, NP
• Kelli Marie Zaccarella, PA-C
• Michael Zaccaria, MSPT
• Pippen Valery Zagabe
• Zaki Badawy, MD PC
• Timothy J Zalepeski, OD
• Griffin Zanoni, PT, DPT
• Sergey Zavilyansky, MD

• Clinical Social Worker in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.

Verify at the official NPI Registry.