Individual provider Active NPI

Jace Arliss

  • Social Worker
  • Lakewood, NJ
National Provider Identifier
1265983928
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
44SL06013700 Issued in NJ
Practice address
700 Airport Rd
Lakewood, NJ 08701-5907
Phone
(732) 757-9014
NPI assigned
Oct 18, 2016
Last updated
Oct 18, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 44SL06013700 NJ Primary

Addresses

Primary practice location

700 Airport Rd
Lakewood, NJ 08701-5907

Mailing address

700 Airport Rd
Lakewood, NJ 08701-5907
Phone (732) 757-9014

Other identifiers 1

IdentifierTypeStateIssuer
0029807MedicaidNJ

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
I20170302000058 NJ Practitioner - Clinical Social Worker 4486938826 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Abby Road Psychiatric Services LLCGroup PAC ID 1658615638, 11 clinicians

Practice addresses (Care Compare)

7 Hendrickson Ave
Red Bank, NJ 07701-6122
Phone (732) 893-5316

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SL06013700NJMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Abby Road Psychiatric Services LLC CurrentSince Oct 13, 2023 Accepting new patients

Locations

7 Hendrickson Ave
Red Bank, NJ 07701
Phone (732) 893-5314

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, 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": "1476748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1265983928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 AIRPORT RD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015907",
            "telephone_number": "732-757-9014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 AIRPORT RD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015907",
            "telephone_number": "732-757-9014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARLISS",
        "first_name": "JACE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06013700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029807",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.