Active NPI
Susan Kermidas, LCSW-R
- Social Worker
- Endicott, NY
National Provider Identifier
1699057620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- R071695-1
- Practice address
- 202 E Main St
Endicott, NY 13760-4817 - Phone
- (607) 754-2660
- Fax
- (607) 754-0769
- NPI assigned
- Sep 15, 2011
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | R071695-1 | NY | Primary |
Addresses
Primary practice location
202 E Main St
Endicott, NY 13760-4817
Mailing address
126 W Chenango Rd
Castle Creek, NY 13744-1410
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R071695-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1699057620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 W CHENANGO RD",
"city": "CASTLE CREEK",
"state": "NY",
"postal_code": "137441410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 E MAIN ST",
"city": "ENDICOTT",
"state": "NY",
"postal_code": "137604817",
"telephone_number": "607-754-2660",
"fax_number": "607-754-0769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERMIDAS",
"first_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-15",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "R071695-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Endicott, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.