Individual provider Active NPI

Jacqueline H Rosenbaum, LCSW

  • Clinical Social Worker
  • Far Rockaway, NY
National Provider Identifier
1730478595
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
088229 Issued in NY
Practice address
1908 Brookhaven Ave
Far Rockaway, NY 11691-3626
Phone
(718) 869-8400
NPI assigned
Apr 1, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 083118 NY
Clinical Social Worker 1041C0700X 088229 NY Primary

Addresses

Primary practice location

1908 Brookhaven Ave
Far Rockaway, NY 11691-3626

Mailing address

1329 Beach Channel Dr
Far Rockaway, NY 11691-3211
Phone (718) 337-6850

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
I20241224000511 NY Practitioner - Clinical Social Worker 0648707018 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
083118NYMDSocial Worker
088229NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St John'S Medical Services PC CurrentSince Dec 1, 2024 Accepting new patients
Episcopal Health Services Inc PastSince Dec 1, 2024 Accepting new patients

Locations

1908 Brookhaven Ave
Far Rockaway, NY 11691
Phone (718) 869-8400

327 Beach 19th St
Far Rockaway, NY 11691
Phone (718) 689-7640

275 Rockaway Tpke
Lawrence, NY 11559
Phone (516) 371-2225

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14448/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jacqueline.rosenbaum.1@14448.direct.athenahealth.com

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": "1301616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1730478595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 BEACH CHANNEL DR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913211",
            "telephone_number": "718-337-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 BROOKHAVEN AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913626",
            "telephone_number": "718-869-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBAUM",
        "first_name": "JACQUELINE",
        "middle_name": "H",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-01",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "083118",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "088229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Far Rockaway, NY

Sources for this page

Verify at the official NPI Registry.