Laura Fanning, LCSW
Individual provider Active NPI Clinical Social Worker · Riverhead, NY
NPI 1922421791 · NPPES record last updated Mar 26, 2019
Key facts
- NPI
- 1922421791
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 090447 (NY)
- Practice address
- 21 E 2ND St Ste 102
Riverhead, NY 11901-4686 - Phone
- (631) 682-7495
- NPI assigned
- Jan 29, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
21 E 2ND St
Suite 102
Riverhead, NY 11901-4686
Phone (631) 682-7495
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180924002118 | NY | Practitioner - Clinical Social Worker | 9830440288 |
Reassigns benefits to 1 organization Practice locations: Riverhead, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090447 | NY | MD | Clinical Social Worker |
Practice roles (3 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities of the Diocese of Rockville Centre | Current | Accepting new patients | |
| Catholic Charities of the Diocese of Rockville Centre | Current |
Accepting new patients | |
| Catholic Charities of the Diocese of Rockville Centre | Current |
Accepting new patients |
Locations
31 E Montauk Hwy
Hampton Bays, NY 11946
Phone (516) 733-7040
90 Cherry Ln
Hicksville, NY 11801
Phone (516) 733-7040
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 090447 | NY | Yes |
Addresses
Primary practice location
21 E 2ND St Ste 102
Riverhead, NY 11901-4686
Mailing address
21 E 2ND St Ste 102
Riverhead, NY 11901-4686
Phone (631) 682-7495
Other providers in Riverhead, NY
- Kevin Fadairo
- Thomas A Falco
- Keith Peter Falsetta
- Family Integrated Consulting and Resources, Inc
- Family Servive League
- Ahmed Essam Farag
- Zeinab Fathelbab
- Gina Marie Fattibene
- Clarissa A Favichia
- John J Fazio
All providers in Riverhead, 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 Mar 26, 2019. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.