Individual provider Active NPI

Gydmer Sosa, L.C.S.W.

  • Clinical Social Worker
  • Manchester, CT
National Provider Identifier
1689014441
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
012700 Issued in CT
Practice address
150 N Main St
Manchester, CT 06042-2086
Phone
(860) 533-3434
NPI assigned
Jun 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 088980-1 NY
Clinical Social Worker 1041C0700X 085800-1 NY
Clinical Social Worker 1041C0700X 012700 CT Primary

Addresses

Primary practice location

150 N Main St
Manchester, CT 06042-2086

Mailing address

150 N Main St
Manchester, CT 06042-2086
Phone (860) 533-3434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20230315001954 CT Practitioner - Clinical Social Worker 5294109161 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prospect Manchester Hospital IncGroup PAC ID 9234423625, 21 clinicians

Practice addresses (Care Compare)

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 646-1222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
088980-1NYMDSocial Worker
012700CTMDClinical Social Worker
085800-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Manchester Hospital, Inc. Clinical CurrentSince Nov 8, 2023 Accepting new patients
Eastern Connecticut Medical Professionals Foundation, Inc Past Accepting new patients

Locations

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1689014441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422086",
            "telephone_number": "860-533-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422086",
            "telephone_number": "860-533-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOSA",
        "first_name": "GYDMER",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "088980-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "085800-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "012700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.