Individual provider Active NPI

Jeannie Dilworth, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Manchester, CT
National Provider Identifier
1265487425
Registry record updated Jul 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
001987 Issued in CT
Practice address
642 Hilliard St Ste 1315
Manchester, CT 06042-2700
Phone
(860) 335-7221
Fax
(833) 901-3911
NPI assigned
May 24, 2006
Last updated
Jul 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 001987 CT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 001987 CT Primary

Addresses

Primary practice location

642 Hilliard St Ste 1315
Manchester, CT 06042-2700

Mailing address

642 Hilliard St Ste 1315
Manchester, CT 06042-2700
Phone (860) 335-6834

Other identifiers 1

IdentifierTypeStateIssuer
004253407MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
1987CTMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
The Hospital of Central Connecticut at New Britain General and Bradley Past Accepting new patients
Medoptions Behavioral Health Assoc, LLC Nurse Practitioner Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753574400000",
    "number": "1265487425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 HILLIARD ST STE 1315",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422700",
            "telephone_number": "860-335-6834",
            "fax_number": "833-901-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 HILLIARD ST STE 1315",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422700",
            "telephone_number": "860-335-7221",
            "fax_number": "833-901-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILWORTH",
        "first_name": "JEANNIE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-07-27",
        "certification_date": "2025-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "001987",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "001987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004253407",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2025; 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.