Tara Anglim, LCSW-R
Individual provider Active NPI Clinical Social Worker · Bayport, NY
NPI 1861746919 · NPPES record last updated Oct 27, 2012
Key facts
- NPI
- 1861746919
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- R071724-1 (NY)
- Practice address
- 166 Gerritsen Ave
Bayport, NY 11705-2162 - Phone
- (631) 944-2909
- NPI assigned
- Oct 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R071724-1 | NY | MD | Clinical Social Worker |
Practice roles (1 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peconic Bay Primary Medical Care | Current |
Accepting new patients |
Locations
34 Commerce Ave
Riverhead, NY 11901
Phone (631) 591-3000
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R071724-1 | NY | Yes |
Addresses
Primary practice location
166 Gerritsen Ave
Bayport, NY 11705-2162
Mailing address
166 Gerritsen Ave
Bayport, NY 11705-2162
Phone (631) 944-2909
Other providers in Bayport, NY
- Ryan Alexandersen
- Lindsay Christine Alimena
- Mary Anderson
- Nancy A Anderson
- Kim M Andrunik
- Shahla Arif
- Emily Arntsen
- Emily Michelle Arpino
- Autism Behavior Consulting, LLC
- Imtisal Awan
All providers in Bayport, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.