Individual provider Active NPI

Jessenia M Cantillo, LCSW

  • Clinical Social Worker
  • New Providence, NJ
National Provider Identifier
1225807092
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05758600 Issued in NJ
Practice address
121 Chanlon Rd
New Providence, NJ 07974-1543
Phone
(973) 299-9954
NPI assigned
Dec 21, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05758600 NJ Primary

Addresses

Primary practice location

121 Chanlon Rd
New Providence, NJ 07974-1543

Mailing address

121 Chanlon Rd
New Providence, NJ 07974-1543

Other names 1

  • Jessenia M Herrera Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20240227003099 NJ Practitioner - Clinical Social Worker 1153766324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jersey Medical Care,PCGroup PAC ID 0941274716, 12 clinicians

Practice addresses (Care Compare)

100 Belchase Dr
Suite 101
Matawan, NJ 07747-9728
Phone (732) 707-4100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05758600NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jersey Medical Care,PC CurrentSince Mar 12, 2024 Accepting new patients

Locations

100 Belchase Dr
Ste 101
Matawan, NJ 07747
Phone (732) 290-1660

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1225807092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CHANLON RD",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079741543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CHANLON RD",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079741543",
            "telephone_number": "973-299-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTILLO",
        "first_name": "JESSENIA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-21",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05758600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSENIA",
            "last_name": "HERRERA",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Providence, NJ

Sources for this page

Verify at the official NPI Registry.