Active NPI
Katherine G Bourgeois, LCSW
- Social Worker
- New York, NY
National Provider Identifier
1881234920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 106686
- Practice address
- 1 Gustave L Levy PL FL 12
New York, NY 10029-6574 - Phone
- (346) 964-3585
- NPI assigned
- Jan 7, 2020
- Reactivated
- Jun 24, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 106686 | NY | Primary |
Addresses
Primary practice location
1 Gustave L Levy PL FL 12
New York, NY 10029-6574
Mailing address
1280 Lexington Ave FRNT 2
New York, NY 10028-2136
Phone (347) 315-4612
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 |
|---|---|---|---|
| 106686 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1881234920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1280 LEXINGTON AVE FRNT 2",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100282136",
"telephone_number": "347-315-4612",
"fax_number": "347-315-4612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GUSTAVE L LEVY PL FL 12",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100296574",
"telephone_number": "346-964-3585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGEOIS",
"first_name": "KATHERINE",
"middle_name": "G",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-07",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"deactivation_date": "2022-05-05",
"reactivation_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "106686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.