Individual provider Active NPI

Jose A. Candelario-Carmona Jr., LCSW

  • Clinical Social Worker
  • Bronx, NY
National Provider Identifier
1811202096
Registry record updated Dec 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
081811 Issued in NY
Practice address
2426 Eastchester Rd Ste 201
Bronx, NY 10469-5950
Phone
(347) 301-6981
NPI assigned
Aug 12, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2019

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 081811 NY Primary

Addresses

Primary practice location

2426 Eastchester Rd Ste 201
Bronx, NY 10469-5950

Mailing address

2426 Eastchester Rd Ste 201
Bronx, NY 10469-5950
Phone (347) 301-6981

Other practice location 1

260 E 188th St
Bronx, NY 10458-5302
Phone (718) 960-3298

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
I20140808000481 NY Practitioner - Clinical Social Worker 5597982900 Reassigns benefits to 1 organization
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
081811NYMDClinical Social Worker

Networks

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

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": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1811202096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2426 EASTCHESTER RD STE 201",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695950",
            "telephone_number": "347-301-6981",
            "fax_number": "866-274-4236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 EASTCHESTER RD STE 201",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695950",
            "telephone_number": "347-301-6981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "260 E 188th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104585302",
            "country_code": "US",
            "telephone_number": "718-960-3298",
            "fax_number": "718-618-8968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANDELARIO-CARMONA",
        "first_name": "JOSE",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-12",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.