Individual provider Active NPI

Stephanie Ann Wayne, LCSW

  • Clinical Social Worker
  • Jamaica, NY
National Provider Identifier
1700200094
Registry record updated Feb 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
081492-1 Issued in NY
Practice address
13534 82ND Dr
Apt 3a
Jamaica, NY 11435-1469
Phone
(914) 319-0959
NPI assigned
Feb 7, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2014

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 081492-1 NY Primary

Addresses

Primary practice location

13534 82ND Dr
Apt 3a
Jamaica, NY 11435-1469

Mailing address

13534 82ND Dr
Apt 3a
Jamaica, NY 11435-1469
Phone (914) 319-0959

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
I20210107001753 NY Practitioner - Clinical Social Worker 8628293321 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
081492-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Living Behavioral Health LCSW PLLC Clinical CurrentSince Jun 1, 2022 Accepting new patients
Sunrise Counseling Center,LTD Clinical CurrentSince Dec 1, 2020 Accepting new patients
Sun River Health Inc Current Accepting new patients
Sun River Health Inc. CurrentSince Dec 12, 2023 Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

6 Henry St
Beacon, NY 12508
Phone (845) 831-0400

1065 Smithtown Ave
Bohemia, NY 11716
Phone (631) 388-7616

107 W Main St
East Islip, NY 11730
Phone (631) 666-1615

550 Montauk Hwy
Shirley, NY 11967
Phone (631) 852-1000

Networks

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

Organizations & group practices 4

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": "1391731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391731200000",
    "number": "1700200094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13534 82ND DR",
            "address_2": "APT 3A",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114351469",
            "telephone_number": "914-319-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13534 82ND DR",
            "address_2": "APT 3A",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114351469",
            "telephone_number": "914-319-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYNE",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-07",
        "last_updated": "2014-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081492-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.