Eastern Door Licensed Clinical Social Work, PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC

Practice address

620 Washington Ave
Rensselaer, NY 12144-1300

Phone

(518) 252-7073

Fax

(518) 252-7073

NPI assigned

Nov 10, 2016

Last updated

Mar 26, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kellyanne Rugenstein, LCSW, PHDNPI 1447363015

Title

Owner

Phone

(518) 252-7073

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kellyanne Rugenstein, PHD, LCSWR

  • Clinical Social Worker
  • Rensselaer, NY
  • NPI 1447363015
  Medicare reassignment Authorized official
• Matthew Van Maastricht, MSW

  • Social Worker
  • Rensselaer, NY
  • NPI 1033924782
  Medicare reassignment NPD
• Robin F Boyd

  • Social Worker
  • Rensselaer, NY
  • NPI 1740953645
  NPD
• Sharon Emerson, LCSW

  • Clinical Social Worker
  • Rensselaer, NY
  • NPI 1649814062
  NPD
• Kayla Gaffney

  • Social Worker
  • Rensselaer, NY
  • NPI 1679153605
  NPD
• Cynthia Wedekind Jacobs

  • Clinical Social Worker
  • Rensselaer, NY
  • NPI 1831924059
  NPD
• Noah James Deturris Poust

  • Clinical Social Worker
  • Albany, NY
  • NPI 1801462676
  NPD
• Felix Sabornido

  • Social Worker
  • Woodstock, NY
  • NPI 1073187878
  NPD
• Chantel Patrice Smith

  • Social Worker
  • Rensselaer, NY
  • NPI 1366018723
  NPD
• Krista Lynn Bonilla

  • Mental Health Counselor
  • Albany, NY
  • NPI 1669289641
  NPD (past)
• Justin Giambruno, LCSW

  • Clinical Social Worker
  • Albany, NY
  • NPI 1770087017
  NPD (past)
• Taryn Heath

  • Social Worker
  • Rensselaer, NY
  • NPI 1114445244
  NPD (past)

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

{
    "created_epoch": "1478736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1528500337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 WASHINGTON AVE",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121441300",
            "telephone_number": "518-252-7073",
            "fax_number": "518-252-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 WASHINGTON AVE",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121441300",
            "telephone_number": "518-252-7073",
            "fax_number": "518-252-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-10",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "RUGENSTEIN",
        "authorized_official_first_name": "KELLYANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-252-7073",
        "authorized_official_credential": "LCSW, PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03068682",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Dupuis
• Jamie Dutcher
• Mary Kyle Dyer-Martin, DO
• Josy Elsa Eapen
• East Greenbush Home Health Aide
• Daphne Economou
• Emily G Edison
• Heidi Edwards
• Allissa Eiser, RDN, CDN
• Lori Ellis

• Clinical Social Worker in Rensselaer, NY
• Providers in Rensselaer, 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 Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.