Nancy Anne Bourque, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

077438 Issued in NY

Practice address

258 Riverside Dr
#2A
New York, NY 10025-6156

Phone

(212) 865-4176

Fax

(212) 865-4176

NPI assigned

Nov 22, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1629370820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 RIVERSIDE DR",
            "address_2": "#2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256156",
            "telephone_number": "212-865-4176",
            "fax_number": "212-865-4176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 RIVERSIDE DR",
            "address_2": "#2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256156",
            "telephone_number": "212-865-4176",
            "fax_number": "212-865-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "NANCY",
        "middle_name": "ANNE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-22",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "077438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson Bourjolly, MD
• Ariel Bourla, MD, PHD
• Alexandra P Bourlas, DO
• Ana Gabriela Bourne, R.N.
• Isadora Caroline Comens Bourne
• Brian Charles Boursiquot, MD
• Jeffrey Boursiquot
• Maty Boury, MD
• Stephane Daniel Bouskila, PA
• Jamie Joe Bousleiman

• Clinical Social Worker in New York, NY
• Providers in New York, 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 Nov 22, 2010; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.