Individual provider Active NPI

Deirdre Jean Holland, LCSW-R

  • Specialist
  • Hicksville, NY
National Provider Identifier
1588604292
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
069863-1 Issued in NY
Practice address
28 E Old Country Rd
Hicksville, NY 11801-4292
Phone
(516) 330-8422
Fax
(516) 294-1388
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 069863-1 NY Primary

Addresses

Primary practice location

28 E Old Country Rd
Hicksville, NY 11801-4292

Mailing address

28 E Old Country Rd
Hicksville, NY 11801-4292
Phone (516) 330-8422

Other identifiers 1

IdentifierTypeStateIssuer
02773513MedicaidNY

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
I20060614000160 NY Practitioner - Clinical Social Worker 6103834684 Practice locations: Hicksville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

28 E Old Country Rd
Hicksville, NY 11801-4292
Phone (516) 330-8422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
069863NYMDMental Health Counselor
069863-1NYMDSpecialist
062293NYMDPharmacist

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1588604292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 E OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014292",
            "telephone_number": "516-330-8422",
            "fax_number": "516-294-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 E OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014292",
            "telephone_number": "516-330-8422",
            "fax_number": "516-294-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "DEIRDRE",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "069863-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02773513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

Verify at the official NPI Registry.