Individual provider Active NPI

Jennifer Vanrensselaer Greene

  • Clinical Social Worker
  • Mooresville, NC
National Provider Identifier
1093373672
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P013107 Issued in NC
Practice address
134 Infield CT
Mooresville, NC 28117-8026
Phone
(704) 799-6824
Fax
(704) 799-6825
NPI assigned
May 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P013107 NC Primary

Addresses

Primary practice location

134 Infield CT
Mooresville, NC 28117-8026

Mailing address

134 Infield CT
Mooresville, NC 28117-8026
Phone (704) 799-6824

Other practice location 1

129 Woodson St
Salisbury, NC 28144-3255
Phone (704) 799-6824

Other practice location 2

2102 Cambridge Beltway Dr
Charlotte, NC 28273-4353
Phone (704) 799-6824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240112004024 NC Practitioner - Clinical Social Worker 1153773247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hope Harbor Counseling and Wellness, PLLCGroup PAC ID 0244688109, 5 clinicians

Practice addresses (Care Compare)

116 Morlake Dr
Suite 202
Mooresville, NC 28117-9211
Phone (704) 954-8347

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P013107NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hope Harbor Counseling and Wellness, PLLC Clinical CurrentSince Dec 4, 2023 Accepting new patients
Lolly Therapeutics, LLC Clinical Past Accepting new patients
Integrative Therapy Concepts Past Accepting new patients

Locations

116 Morlake Dr
Ste 202
Mooresville, NC 28117
Phone (704) 303-1303

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": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1093373672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INFIELD CT",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178026",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 INFIELD CT",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178026",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Woodson St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281443255",
            "country_code": "US",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2102 Cambridge Beltway Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282734353",
            "country_code": "US",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "JENNIFER",
        "middle_name": "VANRENSSELAER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P013107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.