Individual provider Active NPI

Sandra Caserta, LCSW

  • Clinical Social Worker
  • Lake City, FL
National Provider Identifier
1700525425
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW14166 Issued in FL
Practice address
260 S Marion Ave
Lake City, FL 32025-7030
Phone
(386) 697-8842
NPI assigned
Jun 1, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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 SW14166 FL Primary

Addresses

Primary practice location

260 S Marion Ave
Lake City, FL 32025-7030

Mailing address

352 NW Scenic Lake Dr
Lake City, FL 32055-8581
Phone (559) 281-0068

Other names 1

  • Sandra Simonian Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20220820000110 FL Practitioner - Clinical Social Worker 7113300369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oasis of Hope Therapy, LLCGroup PAC ID 4880087261, 5 clinicians

Practice addresses (Care Compare)

260 S Marion Ave
Suite 135
Lake City, FL 32025-7000
Phone (386) 697-8842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW14166FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Oasis of Hope Therapy LLC CurrentSince Jul 1, 2022 Accepting new patients

Locations

260 S Marion Ave
Ste 135
Lake City, FL 32025
Phone (352) 373-4411

Organizations & group practices 1

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": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1700525425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 NW SCENIC LAKE DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320558581",
            "telephone_number": "559-281-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 S MARION AVE",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320257030",
            "telephone_number": "386-697-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASERTA",
        "first_name": "SANDRA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW14166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "SIMONIAN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.