Active NPI
Evelia Margarita Santiago-Gomez, LCSWR
- Clinical Social Worker
- Wallkill, NY
National Provider Identifier
1922090760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R052184
- Practice address
- 2519 Bruynswick Rd
Wallkill, NY 12589-3244 - Phone
- (845) 476-9800
- Fax
- (845) 744-6793
- NPI assigned
- Aug 18, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R052184 | NY | Primary |
Addresses
Primary practice location
2519 Bruynswick Rd
Wallkill, NY 12589-3244
Mailing address
2519 Bruynswick Rd
Wallkill, NY 12589-3244
Phone (845) 476-9800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052184-1 | Other | NY | LCSWR LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R052184 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335484800000",
"number": "1922090760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2519 BRUYNSWICK RD",
"city": "WALLKILL",
"state": "NY",
"postal_code": "125893244",
"telephone_number": "845-476-9800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2519 BRUYNSWICK RD",
"city": "WALLKILL",
"state": "NY",
"postal_code": "125893244",
"telephone_number": "845-476-9800",
"fax_number": "845-744-6793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANTIAGO-GOMEZ",
"first_name": "EVELIA",
"middle_name": "MARGARITA",
"name_prefix": "Ms.",
"credential": "LCSWR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-18",
"last_updated": "2012-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R052184",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSWR LICENSE",
"identifier": "052184-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wallkill, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.