Active NPI
Elizabeth Ann Breck, LCSW
- Social Worker
- Melbourne, FL
National Provider Identifier
1811919483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 13168
- Practice address
- 1040 Mayflower Ave
Melbourne, FL 32940-6729 - Phone
- (203) 824-9877
- NPI assigned
- Jul 24, 2006
- Last updated
- Aug 10, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 003205 | CT | |
| Social Worker | 104100000X | 13168 | FL | Primary |
Addresses
Primary practice location
1040 Mayflower Ave
Melbourne, FL 32940-6729
Mailing address
1040 Mayflower Ave
Melbourne, FL 32940-6729
Phone (203) 824-9877
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Fordham University School of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
77 Wall St
Madison, CT 06443-3121
Phone (203) 824-9877
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3205 | CT | MD | Mental Health Counselor |
| 13168 | FL | MD | Social Worker |
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, 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": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1811919483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 MAYFLOWER AVE",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329406729",
"telephone_number": "203-824-9877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 MAYFLOWER AVE",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329406729",
"telephone_number": "203-824-9877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRECK",
"first_name": "ELIZABETH",
"middle_name": "ANN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CT",
"license": "003205",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "FL",
"license": "13168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.