Individual provider Active NPI

Stephanie Lorraine Rooker, LMSW

  • Clinical Social Worker
  • Woodstock, NY
National Provider Identifier
1740859164
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P110041 Issued in NY
Practice address
404 Zena Rd
Woodstock, NY 12498-2626
Phone
(845) 679-8650
Fax
(845) 679-5485
NPI assigned
Jun 21, 2021
Last updated
Jun 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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 P110041 NY Primary

Addresses

Primary practice location

404 Zena Rd
Woodstock, NY 12498-2626

Mailing address

404 Zena Rd
Woodstock, NY 12498-2626
Phone (845) 670-8650

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
I20240126000624 NY Practitioner - Mental Health Counselor 4486007432 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P110041NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Maverick Family Counseling LCSW PLLC Clinical CurrentSince Jan 12, 2024 Accepting new patients
Maverick Family Counseling Past Accepting new patients

Locations

404 Zena Rd
Woodstock, NY 12498
Phone (845) 679-5271

404 Zena Rd
Ste 2
Woodstock, NY 12498
Phone (845) 315-7902

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1740859164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "124982626",
            "telephone_number": "845-670-8650",
            "fax_number": "845-679-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 ZENA RD",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "124982626",
            "telephone_number": "845-679-8650",
            "fax_number": "845-679-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOKER",
        "first_name": "STEPHANIE",
        "middle_name": "LORRAINE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "P110041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, NY

Sources for this page

Verify at the official NPI Registry.