Bobby L Staley, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

083565 Issued in NY

Practice address

19605 Foothill Ave
Hollis, NY 11423-1413

Phone

(917) 680-0082

NPI assigned

Mar 22, 2013

Last updated

Feb 7, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Staley Psychiatric Nurse Practitioner PLLCGroup PAC ID 7911328075, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Staley Psychiatric Nurse Practitioner PLLC

  • Psychiatry Physician
  • Hollis, NY
  • NPI 1316581267
  Medicare reassignment Care Compare group NPD
• New Horizon Counseling Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • South Ozone Park, NY
  • NPI 1366430563
  Medicare reassignment NPD

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549497600000",
    "number": "1649512112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19825 DUNTON AVE",
            "address_2": "2ND FL",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231409",
            "telephone_number": "917-680-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19605 FOOTHILL AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231413",
            "telephone_number": "917-680-0082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "BOBBY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-22",
        "last_updated": "2019-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "23692",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "083565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Shore Anesthesiology, P.C.
• Andrew Michael Spellen
• SS Global Wealth Inc
• St Albans Nursing Registry Inc.
• Staley Psychiatric Nurse Practitioner PLLC
• State of New York Comptrollers Office
• Stephanie Fuller NP in Family Health PC (Fuller Care Now)
• Donald Stephen
• Eileen Sterling
• Stephanie Suleymanov

• Clinical Social Worker in Hollis, NY
• Providers in Hollis, 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 Feb 7, 2019; 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.