Anita Convertino, LCSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

R0438231 Issued in NY

Practice address

312 Elm St
Fayetteville, NY 13066-1414

Phone

(315) 476-4050

Fax

(315) 425-7268

NPI assigned

Jan 31, 2007

Last updated

Sep 24, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Anita Dayal Former name

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.

Opted out of Medicare

Yes, effective Mar 8, 2018 through Mar 8, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253750400000",
    "number": "1982741849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 ELM ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661414",
            "telephone_number": "315-476-4050",
            "fax_number": "315-425-7268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 ELM ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661414",
            "telephone_number": "315-476-4050",
            "fax_number": "315-425-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONVERTINO",
        "first_name": "ANITA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "R0438231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANITA",
            "last_name": "DAYAL",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey P Collins, REGISTERED NURSE
• Rosemary Ann Collins, M.S.W.
• Julie Y Colvin, MD
• Consultation Services of Central New York - Medicine Provider, PLLC
• Rene L Converse
• Cook Physical Therapy PC
• Mark D Cook, PT
• Deborah Coolhart, PHD, LMFT
• Kris Coolhart, L.M.T.
• Mary Lou Corcoran, PT

• Psychologist in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.