Jessica Lynne Blankenship, LCSW
Individual provider Active NPI Clinical Social Worker · Bristol, CT
NPI 1104975937 · NPPES record last updated Dec 16, 2016
Key facts
- NPI
- 1104975937
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 007322 (CT)
- Practice address
- 420 N Main St
Bristol, CT 06010-4923 - Phone
- (860) 583-5858
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150623002151 | CT | Practitioner - Clinical Social Worker | 9739490392 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bristol Hospital Incorporated | Current |
Accepting new patients |
Locations
420 N Main St
Bristol, CT 06010
Phone (860) 314-4400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | 007322 | CT | Yes |
Addresses
Primary practice location
420 N Main St
Bristol, CT 06010-4923
Mailing address
11 Boulder RDG
Southington, CT 06489-1088
Phone (860) 944-3207
Other providers in Bristol, CT
- Victoria Biondi
- Jeffrey Bitterman
- Robert Black
- Amber Blais
- Connor Marie Blais
- Peter E Bloom Jr.
- Andrew Blovish
- Rajendra Bobba
- Amy Marie Boccaccio
- Janessa Elise Bodzon
All providers in Bristol, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.