Individual provider Active NPI

Christopher Probeyahn, LCSW-R

  • Clinical Social Worker
  • Sayville, NY
National Provider Identifier
1629117502
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R058641-1 Issued in NY
Practice address
100 S Main St Ste 204
Sayville, NY 11782-3148
Phone
(631) 942-6921
Fax
(844) 727-0565
NPI assigned
Feb 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2020

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 R058641-1 NY Primary

Addresses

Primary practice location

100 S Main St Ste 204
Sayville, NY 11782-3148

Mailing address

130 Foster Ave
Sayville, NY 11782-3134
Phone (631) 942-6921

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
I20050225000755 NY Practitioner - Clinical Social Worker 0648223990 Practice locations: Sayville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 S Main St
Suite 204
Sayville, NY 11782-3148
Phone (631) 942-6921

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R058641-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Christopher Probeyahn LCSW PLLC Clinical CurrentSince May 16, 2021 Accepting new patients

Locations

100 S Main St
Ste 204
Sayville, NY 11782
Phone (631) 942-6921

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, 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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1629117502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 FOSTER AVE",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117823134",
            "telephone_number": "631-942-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S MAIN ST STE 204",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117823148",
            "telephone_number": "631-942-6921",
            "fax_number": "844-727-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROBEYAHN",
        "first_name": "CHRISTOPHER",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R058641-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sayville, NY

Sources for this page

Verify at the official NPI Registry.