Active NPI
Jessica Slavin Connelly, LICSW
- Clinical Social Worker
- Malden, MA
National Provider Identifier
1164744280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 115727
- Practice address
- 17 Corey Rd
Malden, MA 02148-1116 - Phone
- (617) 512-8085
- NPI assigned
- Feb 16, 2010
- 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 | 115727 | MA | Primary |
Addresses
Primary practice location
17 Corey Rd
Malden, MA 02148-1116
Mailing address
17 Corey Rd
Malden, MA 02148-1116
Phone (617) 512-8085
Other practice location 1
2464 Massachusetts Ave Ste 313
Cambridge, MA 02140-1648
Phone (617) 512-8085
Other names 1
- Mrs. Jessica Irene Slavin
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://jsctherapy.clientsecure.me/ | Direct |
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 |
|---|---|---|---|
| 115727 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589500800000",
"number": "1164744280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 COREY RD",
"city": "MALDEN",
"state": "MA",
"postal_code": "021481116",
"telephone_number": "617-512-8085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 COREY RD",
"city": "MALDEN",
"state": "MA",
"postal_code": "021481116",
"telephone_number": "617-512-8085"
}
],
"practiceLocations": [
{
"address_1": "2464 Massachusetts Ave Ste 313",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MA",
"postal_code": "021401648",
"country_code": "US",
"telephone_number": "617-512-8085",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CONNELLY",
"first_name": "JESSICA",
"middle_name": "SLAVIN",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-16",
"last_updated": "2020-05-15",
"certification_date": "2020-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "115727",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://jsctherapy.clientsecure.me/",
"affiliation": "N",
"endpointDescription": "SimplePractice Client Portal",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "17 Corey Rd",
"city": "Malden",
"state": "MA",
"country_code": "US",
"postal_code": "021481116",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "SLAVIN",
"middle_name": "IRENE",
"prefix": "MRS.",
"credential": "LICSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Malden, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.