Individual provider Active NPI

William Patrick Fenty II, LCSW

  • Clinical Social Worker
  • Dix Hills, NY
National Provider Identifier
1730303454
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
054186R Issued in NY
Practice address
31 Melrose Rd
Dix Hills, NY 11746-5610
Phone
(631) 425-1168
Fax
(631) 673-0313
NPI assigned
Apr 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 054186R NY Primary

Addresses

Primary practice location

31 Melrose Rd
Dix Hills, NY 11746-5610

Mailing address

31 Melrose Rd
Dix Hills, NY 11746-5610
Phone (631) 425-1168

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
I20090220000289 NY Practitioner - Clinical Social Worker 0446315733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

31 Melrose Rd
Dix Hills, NY 11746-5610
Phone (631) 425-1168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
054186RNYMDClinical Social Worker
054186NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hollow Hills Licensed Clinical Social Work P.C. CurrentSince Nov 9, 1996 Accepting new patients
Hollow Hills Counseling Center Clinical Past Accepting new patients

Organizations & group practices 2

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": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730303454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 MELROSE RD",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117465610",
            "telephone_number": "631-425-1168",
            "fax_number": "631-673-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 MELROSE RD",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117465610",
            "telephone_number": "631-425-1168",
            "fax_number": "631-673-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENTY",
        "first_name": "WILLIAM",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "054186R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dix Hills, NY

Sources for this page

Verify at the official NPI Registry.