Clinical, Consultation and Supervision Services LCSW PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R063179 Issued in NY

Legal business name

CLINICAL, CONSULTATION AND SUPERVISION SERVICES LCSW PLLC

Practice address

3510 Bainbridge Ave Apt S1
Bronx, NY 10467-1419

Phone

(917) 653-8972

Fax

(888) 812-4062

NPI assigned

Sep 20, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Dominique Nerestan, LCSW-RNPI 1467646059

Title

Clinical Social Worker

Phone

(917) 653-8972

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dominique Nerestan, LCSW

  • Clinical Social Worker
  • Carmel, NY
  • NPI 1467646059
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357603200000",
    "number": "1629329438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 TONETTA LAKE RD",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105094134",
            "telephone_number": "845-893-4948",
            "fax_number": "888-812-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 BAINBRIDGE AVE APT S1",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104671419",
            "telephone_number": "917-653-8972",
            "fax_number": "888-812-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL, CONSULTATION AND SUPERVISION SERVICES LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-20",
        "last_updated": "2013-01-08",
        "status": "A",
        "authorized_official_last_name": "NERESTAN",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "917-653-8972",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R063179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "R063179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystal L Cleven, M.D.
• Johanna Theresa Clifford
• Abigail Elizabeth Cline, MD
• Edith I Cline
• Tyron Cline, RN
• Clinton High School
• Delshae Clinton, LAT, ATC
• Mary Clohan
• Megan Cloidt, DDS MPH
• Jason Thomas Clokes, LMSW

• Clinical Social Worker in Bronx, NY
• Providers in Bronx, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.