Omni Psychotherapy, LCSW, P.C.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R978093 Issued in NY

Legal business name

OMNI PSYCHOTHERAPY, LCSW, P.C.

Practice address

180 S Broadway Ste 405
White Plains, NY 10605-1820

Phone

(917) 805-0044

Fax

(718) 684-4896

NPI assigned

Aug 10, 2018

Organization subpart

No

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

Authorized official

Name

Ivan Diller, LCSW-RNPI 1316145816

Title

President

Phone

(917) 805-0044

Specialties & licenses 1

Addresses

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.

• Ivan Diller

  • Clinical Social Worker
  • White Plains, NY
  • NPI 1316145816
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1669951596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S BROADWAY STE 405",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051820",
            "telephone_number": "917-805-0044",
            "fax_number": "718-684-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S BROADWAY STE 405",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051820",
            "telephone_number": "917-805-0044",
            "fax_number": "718-684-4896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "180 S Broadway Ste 409",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "NY",
            "postal_code": "106051820",
            "country_code": "US",
            "telephone_number": "917-805-0044 x91780",
            "fax_number": "718-684-4896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OMNI PSYCHOTHERAPY, LCSW, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "DILLER",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-805-0044",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R978093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace Olubummo, RN
• Adelola Olufemi
• Ali M Omar, MD
• Simone Omeally, CF NP
• Omni Health, Shatika James, DNP, NP in Family Health PLLC
• Oncology & Hematology of White Plains
• Oncology & Hematology of White Plains
• Oncology & Hematology of White Plains, PLLC
• Oncology and Hematology of White Plains, PLLC
• One Source Homecare Supplies Inc.

• Clinical Social Worker in White Plains, NY
• Providers in White Plains, 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 Jul 11, 2019; 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.