NPIMap

Organization Active NPI

Support Evaluation and Intervention Services LCSW P.C

  • Clinical Social Worker
  • Corona, NY
National Provider Identifier
1790185395
Registry record updated Mar 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
080647-1 Issued in NY
Legal business name
SUPPORT EVALUATION AND INTERVENTION SERVICES LCSW P.C
Practice address
4035 Junction Blvd
Corona, NY 11368-2121
Phone
(917) 995-3773
Fax
(212) 656-1412
NPI assigned
Sep 2, 2014
Last updated
Mar 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2017

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

Authorized official

Name
Karina Pena-Toledo, LCSWNPI 1578717575
Title
President
Phone
(917) 995-3773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 080647-1 NY Primary

Addresses

Primary practice location

4035 Junction Blvd
Corona, NY 11368-2121

Mailing address

4035 Junction Blvd
Corona, NY 11368-2121
Phone (917) 995-3773

Other identifiers 1

IdentifierTypeStateIssuer
1578717575OtherNYNPI

National Provider Directory

National Provider Directory

Locations

4035 Junction Blvd
Corona, NY 11368
Phone (917) 995-3773

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489104000000",
    "number": "1790185395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 JUNCTION BLVD",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682121",
            "telephone_number": "917-995-3773",
            "fax_number": "212-656-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 JUNCTION BLVD",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682121",
            "telephone_number": "917-995-3773",
            "fax_number": "212-656-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORT EVALUATION AND INTERVENTION SERVICES LCSW P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-02",
        "last_updated": "2017-03-10",
        "status": "A",
        "authorized_official_last_name": "PENA-TOLEDO",
        "authorized_official_first_name": "KARINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-995-3773",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080647-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1578717575",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.