Individual provider Active NPI

Jennie Gintoli, LCSW

  • Clinical Social Worker
  • St Petersburg, FL
National Provider Identifier
1154814747
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW17503 Issued in FL
Practice address
3251 3Rd Ave N
St Petersburg, FL 33713-8506
Phone
(727) 321-3854
NPI assigned
Jun 8, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW17503 FL Primary

Addresses

Primary practice location

3251 3Rd Ave N
St Petersburg, FL 33713-8506

Mailing address

3251 3Rd Ave N
St Petersburg, FL 33713-8506
Phone (727) 321-3854

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200825003597 FL Practitioner - Clinical Social Worker 2860819612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Truecandor Behavioral Health, LLCGroup PAC ID 9830504034, 13 clinicians

Practice addresses (Care Compare)

13324 Telecom Dr
Temple Terrace, FL 33637-0938
Phone 8134193386106

6320 US Hwy 301 S
Riverview, FL 33578-3829
Phone 8134193386106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW17503FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Truecandor Behavioral Health, LLC CurrentSince Mar 26, 2021 Accepting new patients

Locations

6320 US Highway 301 S
Riverview, FL 33578
Phone (813) 419-3386

6338 US Highway 301 S
Riverview, FL 33578
Phone (813) 245-2148

13324 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 419-3386

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1154814747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3251 3RD AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138506",
            "telephone_number": "727-321-3854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3251 3RD AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138506",
            "telephone_number": "727-321-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GINTOLI",
        "first_name": "JENNIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW17503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.