Individual provider Active NPI

Deborah Edelson, LCSW

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1720126063
Registry record updated Oct 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R050912-1 Issued in NY
Practice address
645 Saint Johns PL
Brooklyn, NY 11216-4112
Phone
(718) 270-2036
Fax
(718) 270-3910
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2017

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 R050912-1 NY Primary

Addresses

Primary practice location

645 Saint Johns PL
Brooklyn, NY 11216-4112

Mailing address

172 5TH Ave
Suite 24
Brooklyn, NY 11217-3597
Phone (718) 857-8150

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
I20051216000296 NY Practitioner - Clinical Social Worker 2668493743 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R050912-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Care Therapy LCSW of New York PLLC Clinical CurrentSince Apr 1, 2023 Accepting new patients

Locations

2719 Hollywood Blvd
Hollywood, FL 33020
Phone (954) 354-2555

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508976000000",
    "number": "1720126063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 5TH AVE",
            "address_2": "SUITE 24",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173597",
            "telephone_number": "718-857-8150",
            "fax_number": "347-413-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 SAINT JOHNS PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112164112",
            "telephone_number": "718-270-2036",
            "fax_number": "718-270-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSON",
        "first_name": "DEBORAH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2017-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R050912-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.