Individual provider Active NPI

Jason M. Perez, LCSW

  • Clinical Social Worker
  • Kensington, CT
National Provider Identifier
1083963771
Registry record updated May 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
009769 Issued in CT
Practice address
26 Chamberlain Hwy
Kensington, CT 06037-1921
Phone
(860) 893-0040
Fax
(860) 893-0046
NPI assigned
Sep 10, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NY
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X 009769 CT Primary

Addresses

Primary practice location

26 Chamberlain Hwy
Kensington, CT 06037-1921

Mailing address

26 Chamberlain Hwy
Kensington, CT 06037-1921
Phone (860) 893-0040

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170517001513 CT Practitioner - Clinical Social Worker 7810264165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Paragon Behavioral Health, LLCGroup PAC ID 1850301508, 10 clinicians

Practice addresses (Care Compare)

26 Chamberlain Hwy
Kensington, CT 06037-1921
Phone 8608930040214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9769CTMDSocial Worker
009769CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Behavioral Health, LLC CurrentSince May 5, 2017 Accepting new patients
Paragon Behavioral Health, LLC CurrentSince May 5, 2017 Accepting new patients

Locations

26 Chamberlain Hwy
Kensington, CT 06037
Phone (860) 893-0040

Organizations & group practices 2

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": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493942400000",
    "number": "1083963771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 CHAMBERLAIN HWY",
            "city": "KENSINGTON",
            "state": "CT",
            "postal_code": "060371921",
            "telephone_number": "860-893-0040",
            "fax_number": "860-893-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 CHAMBERLAIN HWY",
            "city": "KENSINGTON",
            "state": "CT",
            "postal_code": "060371921",
            "telephone_number": "860-893-0040",
            "fax_number": "860-893-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "JASON",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-10",
        "last_updated": "2017-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "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": "CT",
            "license": "009769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kensington, CT

Sources for this page

Verify at the official NPI Registry.