Jessica Jazz Balletta, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012928 Issued in NC

Practice address

3937 Western Blvd
Raleigh, NC 27606-1936

Phone

(919) 821-0790

Fax

(919) 518-9476

NPI assigned

Aug 9, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• The Children'S Aid Society

  • Voluntary or Charitable Agency
  • New York, NY
  • NPI 1124299763
  NPD (past)

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1225385156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5304 MERIDIAN MARKET DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275265760",
            "telephone_number": "718-813-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3937 WESTERN BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276061936",
            "telephone_number": "919-821-0790",
            "fax_number": "919-518-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLETTA",
        "first_name": "JESSICA",
        "middle_name": "JAZZ",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-09",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caleb Sanders Ballard, MOT, OTR/L, CEAS I
• Christiana Ballard
• Zoey Ballard
• Michelle Ballasiotes, OTR/L
• Angel Ballentine, PT
• Richard Ballou
• Amanda Marie Soltes Balmadrid, LCSW
• Charity Balmer
• Rachael Jin-Sun Balmer, BCBA
• Balmscope Wellness, PLLC

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.