Individual provider Active NPI

Katherine Noreen Johnson, LCSW

  • Clinical Social Worker
  • Liberty, NY
National Provider Identifier
1598797235
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
072767 Issued in NY
Practice address
20 Community Lane
Liberty, NY 12754-0716
Phone
(845) 292-8770
Fax
(845) 292-4206
NPI assigned
Jul 6, 2006
Last updated
Oct 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 0663571 NY
Clinical Social Worker 1041C0700X 072767 NY Primary

Addresses

Primary practice location

20 Community Lane
Liberty, NY 12754-0716

Mailing address

2 Chelsea Lane
319 Foxcroft Village
Loch Sheldrake, NY 12759
Phone (845) 436-6390

Other practice location 1

3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245
Phone (800) 275-3243

Other identifiers 1

IdentifierTypeStateIssuer
00398370MedicaidNY

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
I20190123002479 NY Practitioner - Clinical Social Worker 2567709975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Che Senior Psychological Services, PCGroup PAC ID 8022905314, 227 clinicians

Practice addresses (Care Compare)

135 Vanderbilt Ave
Staten Island, NY 10304-2604
Phone (800) 275-3243

447 -449 Lake Shore Dr W
Absolut Care of Dunkirk Nurs
Dunkirk, NY 14048-1479
Phone (800) 275-3243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0663571NYMDSocial Worker
072767NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Che Senior Psychological Services, PC Clinical CurrentSince Dec 4, 2020 Accepting new patients
Knapp Street Psychiatry, PC Clinical CurrentSince Nov 28, 2018 Accepting new patients

Locations

1915 Ocean Ave
Brooklyn, NY 11230
Phone (718) 258-7700

3512 Quentin Rd
Ste 110
Brooklyn, NY 11234
Phone (718) 854-8370

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

209 Beach 125th St
Rockaway Park, NY 11694
Phone (516) 721-7625

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1598797235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CHELSEA LANE",
            "address_2": "319 FOXCROFT VILLAGE",
            "city": "LOCH SHELDRAKE",
            "state": "NY",
            "postal_code": "12759",
            "telephone_number": "845-436-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 COMMUNITY LANE",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127540716",
            "telephone_number": "845-292-8770",
            "fax_number": "845-292-4206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3512 Quentin Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112344245",
            "country_code": "US",
            "telephone_number": "800-275-3243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHERINE",
        "middle_name": "NOREEN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "0663571",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "072767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00398370",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, NY

Sources for this page

Verify at the official NPI Registry.