Jaclyn Mickiewicz, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LICSW126010 Issued in MA

Practice address

26 Severance St
Shelburne Falls, MA 01370-1217

Phone

(413) 775-3432

NPI assigned

Apr 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1295953461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 SEVERANCE ST",
            "city": "SHELBURNE FALLS",
            "state": "MA",
            "postal_code": "013701217",
            "telephone_number": "413-775-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 SEVERANCE ST",
            "city": "SHELBURNE FALLS",
            "state": "MA",
            "postal_code": "013701217",
            "telephone_number": "413-775-3432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKIEWICZ",
        "first_name": "JACLYN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW126010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark D Littlewood, RPH
• Carmelina Lorusso, MSW, LICSW
• Kari Lyden
• Heather Maples, LPN, LHMC
• Morghan McCarthy, C.O.T.A/L
• Robert James Miller, MD
• Barbara Jeanne Miner, R.D.O.
• Thomas Joseph Miner, RDO
• Mohawk Manor Rest Home, Inc
• Mohawk Trail Regional School District

• Clinical Social Worker in Shelburne Falls, MA
• Providers in Shelburne Falls, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.