Individual provider Active NPI

Jody Eve Shatkin, LCSW

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1912089384
Registry record updated Nov 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R039125-1 Issued in NY
Practice address
1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone
(718) 954-3800
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R039125-1 NY Primary

Addresses

Primary practice location

1623 Kings Hwy
Brooklyn, NY 11229-1209

Mailing address

1623 Kings Hwy
Brooklyn, NY 11229-1209

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180102002486 NY Practitioner - Clinical Social Worker 0840558458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interborough Developmental and Consultation Center IncGroup PAC ID 7911898192, 167 clinicians

Practice addresses (Care Compare)

1623 Kings Hwy
Brooklyn, NY 11229-1209
Phone 9292737601426

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R039125-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Nov 27, 2017 Accepting new patients
Interborough Developmental and Consultation Center, Inc. CurrentSince Nov 27, 2017 Accepting new patients

Locations

1623 Kings Hwy
Brooklyn, NY 11229
Phone (718) 307-6800

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1912089384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291209",
            "telephone_number": "718-954-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATKIN",
        "first_name": "JODY",
        "middle_name": "EVE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R039125-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.