Jaclyn Martinez, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011913 Issued in NC

Practice address

3622 Morganton Rd Ste B
Fayetteville, NC 28303-4967

Phone

(910) 212-4441

NPI assigned

Dec 14, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Vollmoeller Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

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.

• Brave Medical P.C.

  • Community/Behavioral Health Agency
  • Yonkers, NY
  • NPI 1902415318
  Medicare reassignment NPD
• Evolving Life Counseling and Psychotherapy PLLC

  • Counselor
  • Durham, NC
  • NPI 1013575141
  NPD
• Sunshine Interventions PLLC

  • Mental Health Counselor
  • Durham, NC
  • NPI 1962121673
  NPD

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

{
    "created_epoch": "1576281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576281600000",
    "number": "1104464775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5424 SILVER PINE CT",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283032744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 MORGANTON RD STE B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283034967",
            "telephone_number": "910-212-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "JACLYN",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-14",
        "last_updated": "2019-12-14",
        "certification_date": "2019-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "VOLLMOELLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ana Janette Martinez, RDN, LDN
• Ana Luisa Martinez
• Caroline Ashley Martinez, MS, BCBA
• Diana Martinez, LMSW
• Emma Martinez
• Marcelino Martinez
• Marlene Jeanette Martinez
• Olga Magalys Martinez
• Sarahi Martinez
• Alyssa Martino

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.