Jean Laroyce Bacon, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

045056-1 Issued in NY

Practice address

83 E Main St
Bay Shore, NY 11706-8305

Phone

(631) 666-5067

Fax

(631) 593-5472

NPI assigned

May 3, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Clinical Social Worker

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Butterfly LCSW PC

  • Clinical Social Worker
  • Bay Shore, NY
  • NPI 1023349297
  Medicare reassignment NPD Authorized official
• Psychiatric Care Medical PLLC

  • Psychiatry Physician
  • Saint James, NY
  • NPI 1952946386
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1184846818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 FIRE ROAD DR",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117063947",
            "telephone_number": "631-834-0388",
            "fax_number": "631-593-5472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068305",
            "telephone_number": "631-666-5067",
            "fax_number": "631-593-5472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1735 N Ocean Ave Ste D",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "NY",
            "postal_code": "117632671",
            "country_code": "US",
            "telephone_number": "631-666-5067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACON",
        "first_name": "JEAN",
        "middle_name": "LAROYCE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "045056-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02896748",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "A400010901",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Awixa Home of Li, Inc
• Maryam Ayaz
• Asad Aziz
• Bab Nuclear Radiology, PC
• Laura Babyatzky, MS, RDN, CLC
• Jasia A Baig, PHD
• Robin Nicole Bailey, LPN
• Shernetta Marva Bailey, RN
• Dewan Chand Bajaj, LMSW
• Tanveer Akhtar Bajwa, M. D.

• Clinical Social Worker in Bay Shore, NY
• Providers in Bay Shore, 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 Apr 14, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.