Individual provider Active NPI

Jennifer Elizabeth Vittek

  • Clinical Social Worker
  • Willoughby, OH
National Provider Identifier
1043723075
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2103244 Issued in OH
Practice address
38882 Mentor Ave
Willoughby, OH 44094-7875
Phone
(440) 953-9999
NPI assigned
Nov 13, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Clinical Social Worker 1041C0700X I.2103244 OH Primary

Addresses

Primary practice location

38882 Mentor Ave
Willoughby, OH 44094-7875

Mailing address

7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20211208000771 OH Practitioner - Clinical Social Worker 9931599883 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.2103244OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Health, Inc. Current Accepting new patients
Signature Health Inc CurrentSince Nov 17, 2021 Accepting new patients
Signature Health, Inc CurrentSince Nov 17, 2021 Accepting new patients

Locations

21100 Southgate Park Blvd
Maple Heights, OH 44137
Phone (216) 663-6100

7232 Justin Way
Mentor, OH 44060
Phone (440) 488-2855

38882 Mentor Ave
Willoughby, OH 44094

38876 Mentor Ave
Willoughby, OH 44094
Phone (440) 954-3333

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1043723075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 JUSTIN WAY",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604881",
            "telephone_number": "440-578-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38882 MENTOR AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947875",
            "telephone_number": "440-953-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITTEK",
        "first_name": "JENNIFER",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2103244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

Verify at the official NPI Registry.