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EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC
NPI 1528500337
Social Worker - Clinical in Rensselaer, NY

Active since November 10, 2016
620 WASHINGTON AVE, RENSSELAER, NY 12144(518) 252-7073(518) 252-7073 Get Directions Write a Review

NPPES record last updated: March 26, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 26, 2025, Jul 26, 2024, Nov 10, 2016 (3 updates tracked since 2016).

About Eastern Door Licensed Clinical Social Work, Pc NPPES

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

EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC (NPI 1528500337) is a healthcare organization registered as a clinical in Rensselaer, New York and active in the NPI registry since November 2016. The organization lists Kellyanne Rugenstein, Owner, as its authorized official.

NPPES Registry Identity

NPI1528500337
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameEASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC
Location Address620 WASHINGTON AVERensselaer, NY 12144-1300
Mailing Address620 Washington AveRensselaer, NY 12144-1300 · (518) 252-7073 · Fax (518) 252-7073
Phone(518) 252-7073
Fax(518) 252-7073
Organization SubpartNo
Authorized OfficialKellyanne RugensteinOwner · (518) 252-7073
Enumeration DateNovember 10, 2016
Last NPPES UpdateMarch 26, 20253 updates tracked since enumeration
NPPES CertifiedMarch 26, 2025
✔ NPI 1528500337 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
620 WASHINGTON AVE, Rensselaer, NY 12144
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Other Identifiers 1

Medicaid03068682NY

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)

Eastern Door Licensed Clinical Social Work, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Eastern Door Licensed Clinical Social Work, PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Kellyanne Rugenstein, PHD, LCSWR
Clinical Social Worker
NPI 1447363015
620 WASHINGTON AVE
Rensselaer, NY 12144
(518) 210-2486
✔ PECOS✔ Accepts MedicareSame address
Matthew Van Maastricht, MSW
Clinical Social Worker
NPI 1033924782
516 WASHINGTON AVE
Rensselaer, NY 12144
(518) 299-9840
✔ PECOS0.1 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 Eastern Door Licensed Clinical Social Work, PC's NPI number?

The NPI number for Eastern Door Licensed Clinical Social Work, PC is 1528500337. It was assigned to this organization in the NPPES registry on November 10, 2016.

Where is Eastern Door Licensed Clinical Social Work, PC located?

Eastern Door Licensed Clinical Social Work, PC is located at 620 Washington Ave, Rensselaer, NY 12144. The listed phone number is (518) 252-7073.

What is Eastern Door Licensed Clinical Social Work, PC's specialty?

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

Is Eastern Door Licensed Clinical Social Work, PC enrolled in Medicare?

Yes. Eastern Door Licensed Clinical Social Work, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eastern Door Licensed Clinical Social Work, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Clinical Social Worker, reassign their Medicare billing to Eastern Door Licensed Clinical Social Work, PC. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Eastern Door Licensed Clinical Social Work, PC was last updated on March 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.