Individual provider Active NPI

Carolyn O'Neal, LCSW

  • Clinical Social Worker
  • Bronx, NY
National Provider Identifier
1689078552
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089075 Issued in NY
Practice address
3209 3Rd Ave
Bronx, NY 10451-4203
Phone
(718) 589-2440
NPI assigned
Oct 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 089075 NY Primary
Social Worker 104100000X 093169-1 NY

Addresses

Primary practice location

3209 3Rd Ave
Bronx, NY 10451-4203

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other practice location 1

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440 ext. 4222

Other identifiers 1

IdentifierTypeStateIssuer
093169-1OtherNYLICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240618003694 NY Practitioner - Clinical Social Worker 0648713628 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
093169-1NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Urban Health Plan, Inc. Current Accepting new patients
Urban Health Plan, Inc. CurrentSince May 12, 2024 Accepting new patients
Urban Health Plan, Inc. CurrentSince May 12, 2024 Accepting new patients

Locations

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

3209 3rd Ave
Bronx, NY 10451
Phone (347) 284-0203

1515 Southern Blvd
#H
Bronx, NY 10460
Phone (718) 589-1600

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Organizations & group practices 3

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": "1413849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1689078552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440",
            "fax_number": "718-991-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514203",
            "telephone_number": "718-589-2440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1065 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104592417",
            "country_code": "US",
            "telephone_number": "718-589-2440 x4222",
            "fax_number": "718-991-4516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'NEAL",
        "first_name": "CAROLYN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-21",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "089075",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "093169-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "093169-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.