Andrea Dejacimo, MSSA, LSW
Individual provider Active NPI Social Worker · Cortland, OH
NPI 1194147678 · NPPES record last updated Jan 17, 2014
Key facts
- NPI
- 1194147678
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- S.1000821 (OH)
- Practice address
- 724 Lakeview Dr
Cortland, OH 44410-1621 - Phone
- (330) 883-1563
- NPI assigned
- Jan 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Thrive Counseling LLC
Practice addresses (Care Compare)
1705 Woodland St NE
Warren, OH 44483-5348
Phone (330) 469-6777
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180829001507 | OH | Practitioner - Clinical Social Worker | 0042560898 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1000821 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Counseling LLC | Current |
Accepting new patients | |
| Thrive Counseling LLC | Current |
Accepting new patients | |
| Psycho Social Therapies,LTD | Current |
Accepting new patients | |
| Psycho Social Therapies,LTD | Current |
Accepting new patients |
Locations
23715 Mercantile Rd
Ste A203
Beachwood, OH 44122
Phone (216) 292-2880
23366 Commerce Park
Ste 100B
Beachwood, OH 44122
Phone (216) 292-2880
1705 Woodland St NE
Warren, OH 44483
Phone (330) 469-6777
1705 Woodland St NE
Ste A
Warren, OH 44483
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/thrivecounselingwarren/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1000821 | OH | Yes |
Addresses
Primary practice location
724 Lakeview Dr
Cortland, OH 44410-1621
Mailing address
724 Lakeview Dr.
Cortland, OH 44410
Phone (330) 883-1563
Other providers in Cortland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.