Individual provider Active NPI

Susan L Roberts

  • Clinical Social Worker
  • Dunkirk, NY
National Provider Identifier
1689711384
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
076506 Issued in NY
Practice address
319 Central Ave
Dunkirk, NY 14048-2137
Phone
(716) 363-3550
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 076506 NY Primary

Addresses

Primary practice location

319 Central Ave
Dunkirk, NY 14048-2137

Mailing address

7 N Erie St
Mayville, NY 14757-1090

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
I20130508000235 NY Practitioner - Clinical Social Worker 1153568308 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
076506NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Chautauqua - a Mun Corp CurrentSince Apr 4, 2013 Accepting new patients
County of Chautauqua - a Mun Corp CurrentSince Apr 4, 2013 Accepting new patients

Locations

319 Central Ave
Dunkirk, NY 14048
Phone (716) 363-3550

200 E 3rd St
Ste 5
Jamestown, NY 14701
Phone (716) 661-8330

3 N Erie St
Mayville, NY 14757

Organizations & group practices 2

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234915200000",
    "number": "1689711384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 N ERIE ST",
            "city": "MAYVILLE",
            "state": "NY",
            "postal_code": "147571090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 CENTRAL AVE",
            "city": "DUNKIRK",
            "state": "NY",
            "postal_code": "140482137",
            "telephone_number": "716-363-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SUSAN",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "076506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunkirk, NY

Sources for this page

Verify at the official NPI Registry.