Active NPI
Stacy Wolberg, LCSW
- Clinical Social Worker
- New York, NY
National Provider Identifier
1689926156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 083804-1
- Practice address
- 220 5TH Ave FL 11
New York, NY 10001-8017 - Phone
- (917) 825-1347
- NPI assigned
- Oct 9, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 083804-1 | NY | Primary |
Addresses
Primary practice location
220 5TH Ave FL 11
New York, NY 10001-8017
Mailing address
220 5TH Ave FL 11
New York, NY 10001-8017
Phone (917) 825-1347
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Feb 23, 2018 through Feb 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083804-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1689926156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 5TH AVE FL 11",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100018017",
"telephone_number": "917-825-1347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 5TH AVE FL 11",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100018017",
"telephone_number": "917-825-1347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLBERG",
"first_name": "STACY",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-09",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "083804-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.