Active NPI
Jacquelyn Nicole Hirsch, LCSW-C
- Clinical Social Worker
- Berlin, MD
National Provider Identifier
1144605593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 20912
- Practice address
- 124 N Main St Ste C
Berlin, MD 21811-1062 - Phone
- (410) 219-5483
- Fax
- (410) 219-5486
- NPI assigned
- Jul 28, 2015
- Last updated
- Jan 16, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 20912 | MD | Primary |
Addresses
Primary practice location
124 N Main St Ste C
Berlin, MD 21811-1062
Mailing address
PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
Other names 1
- Jacquelyn Pisani
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Worcester Youth and Family Counseling Services, Inc. | Current | Accepting new patients |
Locations
124 N Main St
Ste C
Berlin, MD 21811
Phone (410) 641-4598
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Professional Counselor
- Berlin, MD
- NPI 1043254824
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579132800000",
"number": "1144605593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1978",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218021978",
"telephone_number": "410-749-1015",
"fax_number": "410-749-0654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 N MAIN ST STE C",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111062",
"telephone_number": "410-219-5483",
"fax_number": "410-219-5486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIRSCH",
"first_name": "JACQUELYN",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "LCSW-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-28",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "20912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119591300",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELYN",
"last_name": "PISANI",
"credential": "LCSW-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.