Active NPI
Jenaya Tucker, LICSW
- Clinical Social Worker
- Boston, MA
National Provider Identifier
1154916229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 123953
- Practice address
- 200 State St
Boston, MA 02109-2605 - Phone
- (781) 686-3692
- NPI assigned
- Mar 1, 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 | 123953 | MA | Primary |
Addresses
Primary practice location
200 State St
Boston, MA 02109-2605
Mailing address
200 State St
Boston, MA 02109-2605
Phone (781) 686-3692
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 |
|---|---|---|---|
| 123953 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707177600000",
"number": "1154916229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 STATE ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021092605",
"telephone_number": "781-686-3692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 STATE ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021092605",
"telephone_number": "781-686-3692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "JENAYA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-01",
"last_updated": "2024-02-06",
"certification_date": "2024-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "123953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.