Jessica Detor, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

068827 Issued in NY

Practice address

4900 Broad Rd
Physician Office Building North 3N
Syracuse, NY 13215-2265

Phone

(315) 949-1031

NPI assigned

Feb 21, 2019

Last updated

Feb 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Camp Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1164989505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD",
            "address_2": "POB NORTH 3N",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD",
            "address_2": "PHYSICIAN OFFICE BUILDING NORTH 3N",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265",
            "telephone_number": "315-949-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETOR",
        "first_name": "JESSICA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "068827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CAMP",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul Desrochers, MD
• Jessica Lynn Desrosiers
• Kelsey Nicole Desso, RN
• Kathleen Anne Deters-Hayes, LCSW
• Carly Detor, NP
• Morgan M Detor
• Shaunna Rae Detor, RN
• Kimberlyn Vanessa Detrick, D.O
• Nikitha Devaprasad
• Kiran Devaraj, M.D.

• Clinical Social Worker in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.