Active NPI
Salvatore Pennetti, LCSW-R
- Clinical Social Worker
- Port Jefferson, NY
National Provider Identifier
1821082959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 070120-1
- Practice address
- 1000 Main St
Port Jefferson, NY 11777-2250 - Phone
- (631) 828-8600
- NPI assigned
- Sep 5, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 070120-1 | NY | Primary |
Addresses
Primary practice location
1000 Main St
Port Jefferson, NY 11777-2250
Mailing address
1000 Main St
Port Jefferson, NY 11777-2250
Phone (631) 828-8600
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040511000331 | NY | Practitioner - Clinical Social Worker | 6204825607 | Practice locations: Port Jefferson, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1000 Main St
Suite 3
Port Jefferson, NY 11777-2250
Phone (631) 828-8600
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070120-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329782400000",
"number": "1821082959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772250",
"telephone_number": "631-828-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772250",
"telephone_number": "631-828-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNETTI",
"first_name": "SALVATORE",
"name_prefix": "Mr.",
"credential": "LCSW-R",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-05",
"last_updated": "2012-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "070120-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.