Individual provider Active NPI

Dorothy Marie Lilly, RLCSW

  • Clinical Social Worker
  • Port Jefferson, NY
National Provider Identifier
1558444919
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R0433701 Issued in NY
Practice address
14 E Broadway
Port Jefferson, NY 11777-1400
Phone
(631) 689-1141
Fax
(631) 928-8100
NPI assigned
Oct 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R0433701 NY Primary

Addresses

Primary practice location

14 E Broadway
Port Jefferson, NY 11777-1400

Mailing address

147 Sycamore Cir
Stony Brook, NY 11790-3158
Phone (631) 689-1141

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102001109 NY Practitioner - Clinical Social Worker 0648232538 Practice locations: East Setauket, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

290 Main St
Suite 1
East Setauket, NY 11733-2871
Phone (631) 689-1141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R0433701NYMDClinical Social Worker
043370NYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558444919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE CIR",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903158",
            "telephone_number": "631-689-1141",
            "fax_number": "631-928-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 E BROADWAY",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771400",
            "telephone_number": "631-689-1141",
            "fax_number": "631-928-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "DOROTHY",
        "middle_name": "MARIE",
        "credential": "RLCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0433701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.