Active NPI
Jennifer Ann Larson, LMSW
- Social Worker
- Northport, NY
National Provider Identifier
1245703503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 105143-1
- Practice address
- 79 Middleville Rd
Northport, NY 11768-2200 - Phone
- (631) 261-4400
- NPI assigned
- Jan 9, 2019
- Last updated
- Jan 9, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 105143-1 | NY | Primary |
Addresses
Primary practice location
79 Middleville Rd
Northport, NY 11768-2200
Mailing address
15 Meadow LN
Lloyd Harbor, NY 11743-9721
Phone (631) 385-1535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2025 through Oct 1, 2027
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12 Upper Dr
Halesite, NY 11743-1318
12 Upper Dr N
Halesite, NY 11743-1318
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105143-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546992000000",
"number": "1245703503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 MEADOW LN",
"city": "LLOYD HARBOR",
"state": "NY",
"postal_code": "117439721",
"telephone_number": "631-385-1535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117682200",
"telephone_number": "631-261-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JENNIFER",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-09",
"last_updated": "2019-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "105143-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- 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.