Individual provider Active NPI

Laquetta D Solomon, LCSW

  • Clinical Social Worker
  • Bohemia, NY
National Provider Identifier
1609005776
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0767481 Issued in NY
Practice address
606 Johnson Ave Ste 17
Bohemia, NY 11716-2688
Phone
(631) 800-1975
NPI assigned
Jul 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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 0767481 NY Primary

Addresses

Primary practice location

606 Johnson Ave Ste 17
Bohemia, NY 11716-2688

Mailing address

PO Box 401
Medford, NY 11763-0401
Phone (631) 800-1975

Other practice location 1

2100 Deer Park Ave
6A
Deer Park, NY 11729-2119
Phone (631) 800-1975

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0767481NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Elev8Ted Perspectives Consultation Services Clinical CurrentSince Jan 15, 2023 Accepting new patients

Locations

606 Johnson Ave
Ste 17
Bohemia, NY 11716
Phone (631) 800-1975

Networks

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

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": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1609005776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 401",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117630401",
            "telephone_number": "631-800-1975",
            "fax_number": "631-918-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 JOHNSON AVE STE 17",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162688",
            "telephone_number": "631-800-1975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Deer Park Ave",
            "address_2": "6A",
            "address_purpose": "LOCATION",
            "city": "Deer Park",
            "state": "NY",
            "postal_code": "117292119",
            "country_code": "US",
            "telephone_number": "631-800-1975",
            "fax_number": "631-883-8511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "LAQUETTA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "0767481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bohemia, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.