Active NPI
Victoria Nielsen, LMSW
- Social Worker
- Coram, NY
National Provider Identifier
1891353579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 3600 Route 112
Coram, NY 11727-4116 - Phone
- (631) 920-8500
- NPI assigned
- May 29, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 109557-01 | NY | |
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
3600 Route 112
Coram, NY 11727-4116
Mailing address
14202 20TH Ave FL 3
Flushing, NY 11351-3000
Phone (718) 559-0516
Other practice location 1
5225 Rte 347 Ste 44
Port Jefferson Station, NY 11776-2060
Phone (631) 403-3318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 21, 2024 through May 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109557-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1891353579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14202 20TH AVE FL 3",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113513000",
"telephone_number": "718-559-0516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8500"
}
],
"practiceLocations": [
{
"address_1": "5225 Rte 347 Ste 44",
"address_purpose": "LOCATION",
"city": "Port Jefferson Station",
"state": "NY",
"postal_code": "117762060",
"country_code": "US",
"telephone_number": "631-403-3318",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIELSEN",
"first_name": "VICTORIA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-29",
"last_updated": "2020-10-30",
"certification_date": "2020-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "109557-01",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.