Jillian Debenedetto, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC06143700 Issued in NJ

Practice address

Fort Health Medical Group 613 Washing Blvd.
#1297
Jersey City, NJ 10314-1509

Phone

(201) 208-2616

NPI assigned

Aug 20, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Other, 2014

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Baker Street Behavioral HealthGroup PAC ID 3476945098, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Baker Street Behavioral Health

  • Clinical Psychologist
  • Franklin Lakes, NJ
  • NPI 1659841096
  Medicare reassignment Care Compare group NPD
• Coordinated Behavioral Care Ipa Inc

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1457881443
  NPD (past)
• Jewish Board of Family and Children Services

  • Mental Illness Community Based Residential Treatment Facility
  • Staten Island, NY
  • NPI 1295003838
  NPD (past)

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1073861209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 HIGHLAND AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073065802",
            "telephone_number": "732-610-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FORT HEALTH MEDICAL GROUP 613 WASHING BLVD.",
            "address_2": "#1297",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "103141509",
            "telephone_number": "201-208-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBENEDETTO",
        "first_name": "JILLIAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-20",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06143700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne De Rosairo, MD
• Angelica Villacorta De Vera
• Rosanne Deangelis, PA-C
• Dear Tooth Fairy Pediatric Dentistry & Family Orthodontics LLC
• Andy Debaun, LCSW
• Dennis Anthony Debernardis, DO
• Christina Marie Dedeo, DO
• Cecille Natalie Lao Dee, PT
• Deepak Shah, MD,PA
• Maria G. Defalco, MS, PT

• Clinical Social Worker in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.