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Organization Active NPI

Eastsidecounselingservicessyracuse

Doing business as eastsidecounselingservices

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1982070520
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R018157-1 Issued in NY
Legal business name
EASTSIDECOUNSELINGSERVICESSYRACUSE
Doing business as
eastsidecounselingservices
Practice address
216 Pelham Rd
Syracuse, NY 13214-1621
Phone
(215) 606-8654
NPI assigned
Aug 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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

Authorized official

Name
Margaret West Kelly, LCSW-R
Title
Clinical Social Worker
Phone
(215) 606-8654

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X R018157-1 NY Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 077677-1 NY

Addresses

Primary practice location

216 Pelham Rd
Syracuse, NY 13214-1621

Mailing address

216 Pelham Rd
Syracuse, NY 13214-1621
Phone (215) 606-8654

Other identifiers 2

IdentifierTypeStateIssuer
1538446703OtherNYPRIVATE INSURANCE
1235220401OtherNYPRIVATE INSURANCE

Other names 1

  • eastsidecounselingservices Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1982070520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 PELHAM RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141621",
            "telephone_number": "215-606-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 PELHAM RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141621",
            "telephone_number": "215-606-8654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDECOUNSELINGSERVICESSYRACUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "WEST",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "215-606-8654",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R018157-1",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "077677-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "1538446703",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "1235220401",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "eastsidecounselingservices",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.