Active NPI
Jirina Ann Fargeorge, LMSW
- Mental Health Counselor
- Hamden, CT
National Provider Identifier
1114743424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 10066
- Practice address
- 60 Connolly Pkwy BLDG 2B
Hamden, CT 06514-2593 - Phone
- (203) 909-6705
- Fax
- (475) 238-6355
- NPI assigned
- Dec 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10066 | CT | Primary |
Addresses
Primary practice location
60 Connolly Pkwy BLDG 2B
Hamden, CT 06514-2593
Mailing address
60 Connolly Pkwy BLDG 2B
Hamden, CT 06514-2593
Phone (203) 909-6705
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 800424787 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10066 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1114743424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 CONNOLLY PKWY BLDG 2B",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065142593",
"telephone_number": "203-909-6705",
"fax_number": "475-238-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 CONNOLLY PKWY BLDG 2B",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065142593",
"telephone_number": "203-909-6705",
"fax_number": "475-238-6355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARGEORGE",
"first_name": "JIRINA",
"middle_name": "ANN",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-02",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "CT",
"license": "10066",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "800424787",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hamden, CT
- Family First Counseling and Addiction Services LLC
- Family Practice and Internal Medicine of Hamden
- Family Psychiatric Services
- Family Services of Central Connecticut, Inc.
- Jeralyn R Fantarella, D.M.D.
- William Douglas Farmer, M.D.
- Gianna Nicole Farrow
- Moses Amadeus Farrow, LMFT
- Angela Faulhaber
- Jordan Felion
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.