Active NPI
Jacquelyn Kates Agins, LCSW, CT
- Clinical Social Worker
- Philadelphia, PA
National Provider Identifier
1124608344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CW021534
- Practice address
- 1910 Federal St
Philadelphia, PA 19146-2917 - Phone
- (215) 593-4847
- NPI assigned
- Apr 12, 2021
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CW021534 | PA | Primary |
Addresses
Primary practice location
1910 Federal St
Philadelphia, PA 19146-2917
Mailing address
1910 Federal St
Philadelphia, PA 19146-2917
Phone (215) 593-4847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 12, 2024 through Aug 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CW021534 | PA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618185600000",
"number": "1124608344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 FEDERAL ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191462917",
"telephone_number": "215-593-4847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 FEDERAL ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191462917",
"telephone_number": "215-593-4847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGINS",
"first_name": "JACQUELYN",
"middle_name": "KATES",
"credential": "LCSW, CT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-12",
"last_updated": "2021-04-12",
"certification_date": "2021-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW021534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.