Active NPI
Kevin Lee, LCSW
- Clinical Social Worker
- Amityville, NY
National Provider Identifier
1710318134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 088663
- Practice address
- 191 Broadway
Amityville, NY 11701-2790 - Phone
- (631) 264-0058
- NPI assigned
- Dec 11, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 090975 | NY | |
| Clinical Social Worker | 1041C0700X | 088663 | NY | Primary |
Addresses
Primary practice location
191 Broadway
Amityville, NY 11701-2790
Mailing address
191 Broadway
Amityville, NY 11701-2790
Phone (631) 264-0058
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088663 | NY | MD | Clinical Social Worker |
| 090975 | NY | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1710318134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "191 BROADWAY",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "117012790",
"telephone_number": "631-264-0058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 BROADWAY",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "117012790",
"telephone_number": "631-264-0058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KEVIN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-11",
"last_updated": "2021-01-18",
"certification_date": "2021-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NY",
"license": "090975",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "088663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amityville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.