Carmen R Ceballos, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

076791 Issued in NY

Practice address

100 Broadhollow Rd Ste 108
Farmingdale, NY 11735-4813

Phone

(631) 769-7763

Fax

(631) 769-7763

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Live Well Psychotherapy LCSW PLLC

  • Clinical Social Worker
  • Farmingdale, NY
  • NPI 1245995372
  NPD Authorized official
• Psychological Wellness of New York, P.C.

  • Clinical Psychologist
  • Bayville, NY
  • NPI 1861995201
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573948800000",
    "number": "1972675874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BROADHOLLOW RD STE 108",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354813",
            "telephone_number": "631-769-7763",
            "fax_number": "631-769-7763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROADHOLLOW RD STE 108",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354813",
            "telephone_number": "631-769-7763",
            "fax_number": "631-769-7763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEBALLOS",
        "first_name": "CARMEN",
        "middle_name": "R",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "076791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12769900",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Michael Carter
• Kariam Castro
• Caroline Leigh Catapano
• Jessie Cates
• Susan M Cea
• Irlande Celius, M.S.
• Center Island Massage PC
• Central Island Internal Medicine PLLC
• Bindu Rachel Chacko, R.PH.
• Jacqueline A Chaffer, DVM

• Clinical Social Worker in Farmingdale, NY
• Providers in Farmingdale, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.