Active NPI
Patricia Smucker, LCSW
- Clinical Social Worker
- Lido Beach, NY
National Provider Identifier
1659421030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 73074692
- Practice address
- 241 Lagoon Dr W
Lido Beach, NY 11561-4917 - Phone
- (516) 432-9542
- Fax
- (516) 432-9542
- NPI assigned
- Jan 10, 2007
- 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 | 73074692 | NY | Primary |
Addresses
Primary practice location
241 Lagoon Dr W
Lido Beach, NY 11561-4917
Mailing address
241 Lagoon Dr W
Lido Beach, NY 11561-4917
Phone (516) 432-9542
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 12, 2024 through Jun 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73074692 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659421030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 LAGOON DR W",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614917",
"telephone_number": "516-432-9542",
"fax_number": "516-432-9542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 LAGOON DR W",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614917",
"telephone_number": "516-432-9542",
"fax_number": "516-432-9542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMUCKER",
"first_name": "PATRICIA",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "73074692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lido Beach, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.