Active NPI
Jacqueline Sue Friedberg, LCSW
- Clinical Social Worker
- Massapequa, NY
National Provider Identifier
1598875429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R031689-1
- Practice address
- 550 Broadway
Massapequa, NY 11758-5013 - Phone
- (516) 795-2026
- Fax
- (516) 795-2026
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | NY | ||
| Psychoanalyst | 102L00000X | R031689-1 | NY | |
| Clinical Social Worker | 1041C0700X | R031689-1 | NY | Primary |
Addresses
Primary practice location
550 Broadway
Massapequa, NY 11758-5013
Mailing address
550 Broadway
Massapequa, NY 11758-5013
Phone (516) 795-2026
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 066885 | Other | NY | EMPIRE/VALUE OPTIONS/OPTIMUM |
| 7800008 | Other | GHI | |
| P12268310 | Other | MULTIPLAN | |
| 4387 | Other | AFFINITY | |
| 60106 | Other | VETRA | |
| FI1689 | Other | ATLANTIC HEALTH CARE | |
| T166854 | Other | CIGNA | |
| 066885 | Other | EMPIRE VALUE OPTIONS | |
| 0189236 | Other | NY | GHI |
| 208916624 | Other | UNITED BEHAVIORAL HEALTH CARE | |
| 305969A | Other | MAGNACARE | |
| 55247 | Other | HIP | |
| P3179295 | Other | OXFORD | |
| 1061760 | Other | BEACON | |
| 208916624 | Other | NY | UNITED HEALTHCARE |
| 7759668 | Other | NY | AETNA |
| 3795 | Other | CMS |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060124000721 | NY | Practitioner - Clinical Social Worker | 0345264784 | Practice locations: Massapequa, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R031689-1 | NY | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1598875429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 BROADWAY",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117585013",
"telephone_number": "516-795-2026",
"fax_number": "516-795-2026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 BROADWAY",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117585013",
"telephone_number": "516-795-2026",
"fax_number": "516-795-2026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRIEDBERG",
"first_name": "JACQUELINE",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": null,
"primary": false
},
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "NY",
"license": "R031689-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R031689-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE/VALUE OPTIONS/OPTIMUM",
"identifier": "066885",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "7800008",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "P12268310",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AFFINITY",
"identifier": "4387",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VETRA",
"identifier": "60106",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATLANTIC HEALTH CARE",
"identifier": "FI1689",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "T166854",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE VALUE OPTIONS",
"identifier": "066885",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0189236",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH CARE",
"identifier": "208916624",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGNACARE",
"identifier": "305969A",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "55247",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3179295",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON",
"identifier": "1061760",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "208916624",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7759668",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMS",
"identifier": "3795",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.