Active NPI
Grisselle Vega Eustache, LCSW
- Clinical Social Worker
- Elmont, NY
National Provider Identifier
1821361676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 079881
- Practice address
- 21 Norfeld Blvd
Elmont, NY 11003-3616 - Phone
- (516) 437-5902
- NPI assigned
- Feb 9, 2012
- 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 | 075838-1 | NY | |
| Clinical Social Worker | 1041C0700X | 079881 | NY | Primary |
Addresses
Primary practice location
21 Norfeld Blvd
Elmont, NY 11003-3616
Mailing address
21 Norfeld Blvd
Elmont, NY 11003-3616
Phone (516) 437-5902
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 075838-1 | NY | MD | Social Worker |
| 079881 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fort Health Medical Group PA | Clinical | Past | Accepting new patients |
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.
-
- Child & Adolescent Psychiatry Physician
- New York, NY
- NPI 1184341117
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393200000000",
"number": "1821361676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 NORFELD BLVD",
"city": "ELMONT",
"state": "NY",
"postal_code": "110033616",
"telephone_number": "516-437-5902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 NORFELD BLVD",
"city": "ELMONT",
"state": "NY",
"postal_code": "110033616",
"telephone_number": "516-437-5902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EUSTACHE",
"first_name": "GRISSELLE VEGA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-09",
"last_updated": "2014-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "075838-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "079881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmont, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.