Jeffrey Warren Summerville, PSY.D., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

000823 Issued in CT

Practice address

295 Washington Avenue
Suite 9
Hamden, CT 06518-3025

Phone

(203) 287-8227

Fax

(203) 287-9502

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in CT

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.

Enrollment records 1

Specialty

Clinical Social Worker

Education

University of Connecticut School of Medicine, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Laurel Health Services LLCGroup PAC ID 4284639261, 3 clinicians

Practice addresses (Care Compare)

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.

• Laurel Health Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hamden, CT
  • NPI 1891716627
  Medicare reassignment Care Compare group Authorized official
• Family First Counseling and Addiction Services LLC

  • Marriage & Family Therapist
  • Hamden, CT
  • NPI 1780318527
  NPD

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1013926708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 WASHINGTON AVENUE",
            "address_2": "SUITE 9",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183025",
            "telephone_number": "203-287-8227",
            "fax_number": "203-287-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 WASHINGTON AVENUE",
            "address_2": "SUITE 9",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183025",
            "telephone_number": "203-287-8227",
            "fax_number": "203-287-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERVILLE",
        "first_name": "JEFFREY",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "000823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "140000823CT01",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Stutzman
• Infiniti Suggs
• Amahri Janay Sullins
• Jennifer L Sullivan, PA-C
• Craig Paul Summers, M.D., F.A..A..P.
• Jeffrey M Sumner, M.D.
• Dharini Sun, M.D.
• Laura Superchi
• Supportive Solutions Behavioral Health and Wellness LLC
• Jennifer Suski, FNP

• Clinical Social Worker in Hamden, CT
• Providers in Hamden, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.