Joan Mesmeringer Jurkowski, LCPC
Individual provider Active NPI Counselor · Phoenix, MD
NPI 1124122247 · NPPES record last updated Nov 30, 2016
Key facts
- NPI
- 1124122247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- LC0271 (MD)
- Practice address
- 3313 Paper Mill Rd
Suite 5
Phoenix, MD 21131-1465 - Phone
- (410) 790-9604
- NPI assigned
- Sep 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- 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 |
|---|---|---|---|---|
| I20240117004329 | MD | Practitioner - Mental Health Counselor | 2163874900 | Practice locations: Phoenix, MD |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC0271 | MD | MD | Counselor |
| ACO998 | MD | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LC0271 | MD | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ACO998 | MD |
Addresses
Primary practice location
3313 Paper Mill Rd
Suite 5
Phoenix, MD 21131-1465
Mailing address
3313 Paper Mill Rd
Suite 5
Phoenix, MD 21131-1465
Phone (410) 790-9604
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002627 | Other | MD | BEACON HEALTH |
| 152866 | Other | MD | MHNET |
| 446530000 | Medicaid | MD | |
| R8950001 | Other | MD | CAREFIRST BCBS |
| 2282454 | Other | MD | CIGNA |
Other providers in Phoenix, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 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.