Jessica M Gagnon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

428 Long Hill Rd Ste 201
Groton, CT 06340

Phone

(860) 705-2840

NPI assigned

Jul 20, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• United Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayville, CT
  • NPI 1063413011
  Medicare reassignment NPD

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

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534636800000",
    "number": "1194038174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 LONG HILL RD # 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403811",
            "telephone_number": "860-800-2107",
            "fax_number": "860-450-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 LONG HILL RD STE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "06340",
            "telephone_number": "860-705-2840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1007 N Main St",
            "address_purpose": "LOCATION",
            "city": "Dayville",
            "state": "CT",
            "postal_code": "062412170",
            "country_code": "US",
            "telephone_number": "860-456-2261 x5634",
            "fax_number": "860-450-1357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "JESSICA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-20",
        "last_updated": "2018-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004040564",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Fretto, OD
• George Charles Fricke
• James Joseph Fritz, MD
• Alexandra Frobel, MFT
• Lynn M Gagner, D.C.
• Faustino Torres Galang Jr., PHYSICAL THERAPIST
• Stewart Edward Galeucia, OD
• Maria Mormay Gallagher, LCSW
• Rosalinda G Gaona, MD
• Christopher Daniel Garner, IDC

• Clinical Social Worker in Groton, CT
• Providers in Groton, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2018; 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.