Active NPI
Bonnie Eileen Hallett, LCSW
- Clinical Social Worker
- Wellsville, NY
National Provider Identifier
1619048824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R045218-1
- Practice address
- 112 Park Ave
Wellsville, NY 14895-1162 - Phone
- (585) 593-7781
- Fax
- (585) 593-1291
- NPI assigned
- Nov 10, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R045218-1 | NY | Primary |
Addresses
Primary practice location
112 Park Ave
Wellsville, NY 14895-1162
Mailing address
112 Park Ave
Wellsville, NY 14895-1162
Phone (585) 593-7781
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00054374001 | Other | UNIVERA INS | |
| 00152483 | Other | NORTH AMERICAN PREFERRED | |
| 71-02112027 | Medicaid | NY | |
| 162167 | Other | VALUOPTIONS | |
| 000526101001 | Other | BLUE CROSSBLUE SHEILD | |
| HB603100 | Other | GHI |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R045218-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619048824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 PARK AVE",
"city": "WELLSVILLE",
"state": "NY",
"postal_code": "148951162",
"telephone_number": "585-593-7781",
"fax_number": "585-593-1291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 PARK AVE",
"city": "WELLSVILLE",
"state": "NY",
"postal_code": "148951162",
"telephone_number": "585-593-7781",
"fax_number": "585-593-1291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLETT",
"first_name": "BONNIE",
"middle_name": "EILEEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R045218-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA INS",
"identifier": "00054374001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH AMERICAN PREFERRED",
"identifier": "00152483",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "71-02112027",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUOPTIONS",
"identifier": "162167",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSSBLUE SHEILD",
"identifier": "000526101001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "HB603100",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.