Ebony C Booker, LCSW
Individual provider Active NPI Clinical Social Worker · College Park, GA
NPI 1689288045 · NPPES record last updated Sep 3, 2020
Key facts
- NPI
- 1689288045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CSW006762 (GA)
- Practice address
- 135 Alicante St
College Park, GA 30349-8493 - Phone
- (404) 707-5743
- NPI assigned
- Sep 3, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201124003219 | GA | Practitioner - Clinical Social Worker | 0244641108 |
Reassigns benefits to 3 organizations Practice locations: College Park, GA |
| I20231229002129 | NY | Practitioner - Clinical Social Worker | 0244641108 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Southeast Permanente Medical Group | Current |
Accepting new patients | |
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Sondermind Provider Network LLC | Clinical | Current |
Accepting new patients |
| Grow Healthcare Group PA | Clinical | Current |
Accepting new patients |
| Essential Wellness and Consulting | Current |
Accepting new patients | |
| Valera Medical, P.C. | Clinical | Current |
Accepting new patients |
Locations
3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000
3348 Peachtree Rd NE
Ste 700
Atlanta, GA 30326
Phone (720) 712-7900
134 N 4th St
Brooklyn, NY 11249
139 Centre St
Ste 824
New York, NY 10013
Phone (646) 450-7751
Interoperability endpoints
- ebonybooker@tdh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW006762 | GA | Yes |
Addresses
Primary practice location
135 Alicante St
College Park, GA 30349-8493
Mailing address
135 Alicante St
College Park, GA 30349-8493
Phone (404) 707-5743
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NONE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | NONE | Other |
Other providers in College Park, GA
- Helena K Bentley
- Scott Bertrand
- Beyond Mental Wellness
- Michelle L Bigelow
- Bio-Medical Applications of Georgia, Inc.
- Monica Denise Borum
- Mary Botchey
- BR8K Thru Support Services
- Kira S Bradley
- William Brady
All providers in College Park, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.