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LEGACY LEAGUE FAMILY WELLNESS LLC
NPI 1487361234
Social Worker - Clinical in Jamaica, NY

Active since November 01, 2022
14215 110TH AVE, JAMAICA, NY 11435(917) 923-5341 Get Directions Write a Review

NPPES record last updated: November 1, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Legacy League Family Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY LEAGUE FAMILY WELLNESS LLC (NPI 1487361234) is a healthcare organization registered as a clinical in Jamaica, New York and active in the NPI registry since November 2022. The organization lists Twila Evanson, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1487361234
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameLEGACY LEAGUE FAMILY WELLNESS LLC
Location Address14215 110TH AVEJamaica, NY 11435-5624
Mailing Address14215 110th AveJamaica, NY 11435-5624 · (917) 923-5341
Phone(917) 923-5341
Organization SubpartNo
Authorized OfficialTwila EvansonExecutive Director · (917) 923-5341
Enumeration DateNovember 1, 2022
NPPES CertifiedNovember 1, 2022
✔ NPI 1487361234 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
14215 110TH AVE, Jamaica, NY 11435
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Legacy League Family Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Legacy League Family Wellness LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Twila Evanson, LCSW
Clinical Social Worker
NPI 1104249424
201 BARBEY ST
Brooklyn, NY 11207
(917) 923-5341
✔ PECOS✔ Accepts Medicare4.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy League Family Wellness LLC's NPI number?

The NPI number for Legacy League Family Wellness LLC is 1487361234. It was assigned to this organization in the NPPES registry on November 1, 2022.

Where is Legacy League Family Wellness LLC located?

Legacy League Family Wellness LLC is located at 14215 110th Ave, Jamaica, NY 11435. The listed phone number is (917) 923-5341.

What is Legacy League Family Wellness LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Legacy League Family Wellness LLC enrolled in Medicare?

Yes. Legacy League Family Wellness LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Legacy League Family Wellness LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Social Worker) reassigns their Medicare billing to Legacy League Family Wellness LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Legacy League Family Wellness LLC was last updated on November 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.