Individual provider Active NPI

Andrea Hope Davanzo, LCSWR

  • Clinical Social Worker
  • Woodmere, NY
National Provider Identifier
1578620332
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R0287621 Issued in NY
Practice address
124 Franklin Place
Peninsula Counseling Center
Woodmere, NY 11598
Phone
(516) 569-6600
Fax
(516) 374-2261
NPI assigned
Jan 2, 2007
Sex
Female
Sole proprietor
No

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 R0287621 NY Primary

Addresses

Primary practice location

124 Franklin Place
Peninsula Counseling Center
Woodmere, NY 11598

Mailing address

124 Franklin Place
Peninsula Counseling Center
Woodmere, NY 11598
Phone (516) 569-6600

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
I20051202000757 NY Practitioner - Clinical Social Worker 7911927058 Reassigns benefits to 1 organization
Practice locations: Island Park, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

153 Lincoln Ave
Island Park, NY 11558-1835
Phone (516) 510-1765

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R0287621NYMDClinical Social Worker
028762NYMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578620332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 FRANKLIN PLACE",
            "address_2": "PENINSULA COUNSELING CENTER",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "11598",
            "telephone_number": "516-569-6600",
            "fax_number": "516-374-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 FRANKLIN PLACE",
            "address_2": "PENINSULA COUNSELING CENTER",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "11598",
            "telephone_number": "516-569-6600",
            "fax_number": "516-374-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVANZO",
        "first_name": "ANDREA",
        "middle_name": "HOPE",
        "name_prefix": "Mrs.",
        "credential": "LCSWR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0287621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodmere, NY

Sources for this page

Verify at the official NPI Registry.